HC Deb 14 November 2000 vol 356 cc805-25 3.31 pm
The Secretary of State for Health (Mr. Alan Milburn)

With permission, Mr. Speaker, I wish to make a statement about the resources being made available to local health services in all parts of England, and the priorities for reform in the NHS.

In the past three years the NHS has treated 2.3 million more patients. It now employs 10,000 more nurses and more than 5,000 more doctors. Waiting lists for in-patient treatment have fallen by 126,000. For the first time since records began, last year saw the number of patients waiting for out-patient appointments and in-patient treatments falling simultaneously. Every accident and emergency department that needs it, and 1,000 general practitioners' surgeries, are being modernised. The biggest hospital-building programme in the history of the NHS is under way.

After decades of neglect, the NHS is now expanding its services to patients. For two decades or more, the NHS budget rose by an average of just 3 per cent. a year. In the previous Parliament it rose by rather less than that—by just 2.6 per cent. In this Government's first two years in office, spending on the NHS did not rise as quickly as many had hoped. However, the tough choices that we took then are paying off for the NHS now. Interest rates and inflation are at historic lows. Unemployment is down, employment is up. The public finances are back in balance. A strong and growing economy is providing the foundation for strong and growing public services.

Over the five years from 1999, the NHS budget will grow by one half in cash terms and by one third in real terms. This year, and for the next three years, the real-terms annual increase in NHS funding will be 6.3 per cent—twice the trend growth of the past few decades.

Today I can inform the House of the funding allocations for each health authority in England. The cash is for revenue purposes. I will be making announcements in due course about capital resources. Details of today's allocations for the local health authorities in right hon. and hon. Members' constituencies are available in the Vote Office. I have also written today to all right hon. and hon. Members with details.

For the first time in the history of the NHS, I am making outline revenue allocations for the next three years rather than just for a single year ahead. This will allow every local health service to plan with confidence for the medium term rather than just for the short term. As right hon. and hon. Members are aware, there has been too much boom and bust in NHS funding in the past. Today we bring that to an end. [Interruption.] I knew that would excite them, Mr. Speaker. From April next year, health authorities will receive an average cash increase of 8.5 per cent. No health authority will receive less than 7.8 per cent. The average rise in cash terms for a health authority next year will be £29 million.

I can also announce today that every health authority will benefit from a further rise of at least 6 per cent. in 2002–03 and a further increase of at least 6 per cent. in 2003–04. Those increases are the minimum that all health authorities can expect to receive, with final allocations to be made in the autumn of next year and the year after. I know that the House will want to compare the increase in investment for next year and the following years with allocations in previous years. For the benefit of right hon. and hon Members on both sides of the House, let me explain that in the last year of the last Parliament the NHS budget actually fell in real terms. I am pleased to tell the House that, after years of under-investment, the NHS is now growing again.

Of course, different parts of the country have different health needs. The Government are currently reviewing the formula according to which we distribute NHS cash to ensure that it is better focused on addressing those needs properly and fairly. In the meantime, I will make a number of important changes for next year. First, I am more than doubling, to £130 million, the resources available within health authority allocations to help address some of the appalling health inequalities that scar our nation. Life expectancy for a baby boy born in Manchester is six and a half years less than that for a baby born in east Surrey. The existing funding formula does not take full account of the excess morbidity and mortality from cancer, coronary heart disease and other causes in those areas, as expressed through rates of years of lost life. The extra funding will help places in the north and midlands such as Bury, Rochdale, Calderdale, Kirklees, Dudley, Leeds, Leicestershire, Manchester, Newcastle, north-west Lancashire, Nottingham, Sandwell, Tees and Wakefield. It will also help areas in the south such as Bedfordshire, Brent, Cornwall, east Kent, Herefordshire, Lambeth and south and west Devon. Those extra resources will help to narrow the health gap between the better-off and the worst-off.

Secondly, I am making available a further £65 million to pay a new cost of living supplement for 100,000 qualified nurses, midwives, health visitors and those in professions allied to medicine, such as physiotherapists and radiographers, who work in the highest-cost parts of England. From next April, there will be a minimum of £600 extra for every one of these staff working in London, over and above current London weighting, and up to £1,000 for ward sisters and senior nurses in the capital. Staff in those groups who are working in the highest-cost areas outside London such as Avon, Berkshire, Buckinghamshire, Cambridgeshire, Hertfordshire, Oxfordshire, Surrey, Sussex and Wiltshire will receive between £400 and £600 each. Those extra resources will help in our efforts to recruit an extra 20,000 nurses and 6,500 therapists to the NHS over the next four years.

There is a one further change that I am making to the way the local health service is funded. In the past, there have been too few means to drive up performance and tackle unacceptable variations between local health services. If the NHS is to make progress, it must move from a position in which it bails out failure to one in which it rewards success. The best NHS organisations should have more freedom and more resources to expand their services to more patients, and the worst should have more help to enable them to improve. For next year, I am making available a new £100 million performance fund to provide a clear financial incentive to all parts of the NHS to improve local services. The fund will rise to £500 million by 2003–04. The best local services will be free to spend their share of the fund on equipment, facilities or cash bonuses for staff. The worst will still get a fair share of the fund, but it will be held by the new modernisation agency to use for targeted external assistance to help turn round performance. We will no longer tolerate second-rate services in any part of the NHS. The lottery in patient care must now come to an end.

The extra investment that we are making will bring about the major reforms that the NHS needs. At present, services are too slow, standards too variable and staff too often run off their feet. In July, the Government published the NHS plan, which describes the radical reforms necessary to redesign the service around the needs of its patients. The money that I am allocating today will raise the pace of implementation. Next month, I will publish a detailed NHS plan implementation programme for the health service and for social services. It will detail the investment and the progress that will have to be made over the next year—for example, in improvements in hospital standards, and in services for elderly people, children in care and patients with mental illness.

The next year will see a major expansion in beds, staff and services. Improved co-operation between health and social services, for example, will deliver more packages of intermediate care support to benefit 60,000 elderly people, so that in every council area in every part of the country more older people can live independently at home. The result will be lower rates of delayed discharges from hospitals in all parts of the country. It is crucial that the resources now available to the health service should allow a proper focus on how we can bring about improvements in health, not just an increase in the scale of investment in health services.

The allocations to health authorities will fund a further £450 million to help tackle our country's biggest killers—cancer and coronary heart disease. Our rates of both diseases are too high, and both are largely preventable. The extra resources will mean more drugs to combat cancer and heart disease, more help for people to give up smoking—a major cause of cancer and heart disease—and more operations provided more quickly for more people with cancer and heart disease. By December next year, for example, there will be a new maximum one-month wait from urgent general practitioner referral to treatment in hospital for men with testicular cancer, for children with cancer and for patients of all ages with acute leukaemia. Similarly, by March 2002, three in four eligible heart attack victims will receive life-saving, clot-busting drugs—thrombolysis—within 30 minutes of arrival at hospital. At present, many people wait twice as long.

Waiting is the public's number one concern about the health service. That is why the Government have placed such strong emphasis on winning the war on waiting in the NHS. The NHS plan set out how waiting times will reduce by 2005. The waiting time for seeing a GP will fall to 48 hours, for being seen in accident and emergency departments to an average of 75 minutes, for out-patient appointments to a maximum of three months, and for in-patient treatment to a maximum of six months. By 2008, there will be waits for hospital treatment of weeks rather than months.

The investment that we will make over the next year will deliver real progress towards those shorter waiting times. At present, 126,000 patients wait more than 26 weeks for an out-patient appointment. By March 2002, no one should wait that long, and the number of people waiting for 13 weeks will also have been reduced. Similarly, the maximum waiting time for in-patient treatment is currently 18 months—a target set, but never achieved by the previous Government. We estimate that about 50,000 people wait between 12 and 18 months for a hospital operation. By spring 2002, the NHS will have reduced the numbers waiting more than 12 months, and the maximum waiting time will have been reduced from 18 to 15 months for all patients.

I recognise that these new maximum waiting times are still too long, but they represent the first instalment on real progress towards the NHS plan objectives. The NHS is in a position to deliver substantial improvements for patients because of the commitments that the Government have made to it. While some in this House say that they have philosophically moved on from the NHS, the Government remain committed to the NHS and its survival and modernisation. We have made our choice. Our choice is an NHS providing care according to need, not ability to pay. Our choice is a tax-funded health service, available to all, and not a privatised system of care available to only a few. Our choice is long-term investment in our key public services, not cats in those services. Our choice is record levels of investment, alongside a radical programme of reform.

The step change in the resources that we have made available to the NHS must now produce a step change in results. None of what follows will be easy. Much of it will take time. However, the NHS now has the best opportunity that it has ever had to bring about the radical changes needed to give patients better and faster services. The resources that I have committed today will bring about improvements in health and health care in all parts of the country. I commend them to the House.

Dr. Liam Fox (Woodspring)

I thank the Secretary of State for his statement, and for his courtesy in making a copy available to the Opposition in advance.

Given the huge potential importance of the NHS plan, I am sorry that the House has not yet held a debate on the full plan in Government time, but as the Leader of the House is sitting on the Treasury Bench, I hope that she might take note of that point and make time available so that the House can discuss the plan in the detail it deserves.

The Secretary of State did not say much that was new; in many cases, he made a series of re-announcements, but we have got used to that. However, we very much welcome parts of the statement. As we have said previously, we welcome the increased funding that the Government are making available. Again, we pledge to match that increase in NHS funding.

I also welcome the right hon. Gentleman's attempts to tackle inequalities in health care. That is most important. But it must be done in such a way as not to rob Peter to pay Paul, and by levelling up services rather than levelling them down.

I welcome the extra resources for staff in high-cost areas; I notice that the Secretary of State has kindly—as might have been expected—included my own. I welcome the fact that cancer and cardiac care are to be made a priority; as I have often pointed out to the House, that would also be the priority under the next Conservative Government. I particularly welcome the specific mention of acute leukaemia. I undertook my junior doctor training in a leukaemia unit in the Glasgow Royal infirmary; that disease should be one of the priorities.

I also welcome three-year budget setting, although there is no use in doing that if there is constant interference from the centre and a constant re-setting of priorities once budgets have been set locally.

The Secretary of State says that the NHS is growing again. This year, however, the Government's figures show that since last winter there has been a reduction in the number of intensive care beds, acute beds and residential care beds. We now have the concept of the funded bed blocker—whereby people who already have a social services funding package block acute beds because there is nowhere to put them. What does the Secretary of State intend to do about that?

Will the Secretary of State give the House answers to the following specific questions? He says that, over the next year, there will be an expansion in the number of beds. Where will they be? How many extra beds does he expect to be provided in the NHS? In which sectors will they be? Will they be in the hospital sector? What is his estimate of the impact on bed numbers of the private finance initiative?

The Secretary of State refers to the allocations to health authorities—funding of a further £450 million to help to tackle cardiac and cancer care. Is that ring-fenced money? Will he clarify that point so as to avoid misinterpretation of his statement?

There is to be more help for those people who want to give up smoking. The Government's cancer tsar says that their anti-smoking strategy is "misdirected" and poorly managed. What is the position on Zyban? In April, the Department of Health promised GPs guidance on who should receive the drug and in what circumstances. That guidance never materialised, and there is now piecemeal provision. Will the Secretary of State clear up that matter?

The Secretary of State tells us that by March 2002, three in four eligible patients will receive thrombolysis treatment, but that means that one in four will not. What conceivable reason could there be for not making that treatment available?

The right hon. Gentleman talks about reducing inequalities, but as he is aware, one of the big problems is not only the provision of services but their uptake. For example, he will know of the problems of uptake in the inner cities for programmes such as those for cervical smears. What specific measures will he introduce to make sure that uptake matches any increased provision?

The Secretary of State talks about redefining the formula for allocating funding. Can he give the House an indication of how he expects that to work, although I do not expect him to provide the details now?

The Secretary of State talks about the lottery in patient care coming to an end. We have all read the spin today about extra money being made available for cancer drugs. Can he tell us the position on that? As the National Institute for Clinical Excellence has been given the criterion of affordability by the Government, what impact will his statement and the funding that he makes available have on affordability of cancer drugs? What does he expect to happen? It is pointless saying that cancer will become a priority and it is pointless even providing more specialists if there is not then access to diagnostics and the treatment is not made available to patients. That is the most important issue of all.

I welcome the recent concordat that the Secretary of State has signed with the private sector. It could allow for the type of public-private partnership that is enjoyed in most European countries. If the Government have genuinely moved ideologically, we welcome that. However, will he confirm that the concordat is not just about NHS doctors treating NHS patients in private facilities, but that it will allow primary care trusts to buy services for patients in the private sector using only NHS funding? That is our understanding from reading it.

The Secretary of State's statement promises much, but he has promised before. The improvements that he claims exist are not borne out by the experience of the public. Only yesterday we heard that the waiting time to get on the waiting list had gone up. Where the Government make improvements, we will welcome them. However, they are now setting targets for hospital waits for 2008—a far cry from the early pledges and "24 hours to save the NHS". The Prime Minister recently said that he did not understand the scale of the problem that he faced in the NHS. Nothing that the Secretary of State has said today reassures us that he does, either.

Mr. Milburn

I thank the hon. Gentleman for his grateful acceptance of the cash. Perhaps that is not surprising. I remind him that, in the last year of the previous Government, his health authority received an increase of about 3 per cent. This year, it is receiving an increase of just under 9 per cent.

I am also grateful to the hon. Gentleman for his latter-day conversion to the idea of tackling inequality. In 1992, he was the hon. Member who said: poverty, poverty, poverty—la, la, la,…It is just boring for Conservative Members.—[Official Report, 22 October 1992; Vol. 212, c. 636.] On the specific issues of the funding formula that the hon. Gentleman raises, he will know, as well as I do, that there is no perfect means of allocating money to health authorities. Most people in the health service now recognise that the current funding formula simply does not do the trick and does not get the money to where it is most needed. We have therefore set up a review that is being conducted by an expert panel. It is due to report over the next few years. It is a complicated issue, and it is important that we conduct the review in parallel with the local government review of funding allocations. lf, as most hon. Members want, we are to move towards closer co-operation between health, housing and social services, it is important to get the funding allocations for local government and the health service much more in tandem than they perhaps are now.

The hon. Gentleman raised the issue of cancer drugs, and I can confirm that 13 up-to-date cancer drugs have been referred to the National Institute for Clinical Excellence. It is due to report in the summer of 2001, and we have made provision in the health authority allocations. However, that provision will depend on what NICE comes up with. It is true that, when we have previously referred cancer drugs to NICE—most notably, the taxanes, which we referred last year and this year—the result has been a dramatic uptake in the number of patients receiving high-quality cancer drugs. I think that one in four patients with ovarian cancer and three in four patients with breast cancer did not receive taxanes before the NICE recommendation. However, every patient who needs taxanes now receives them, thanks to the decisions of NICE, a body that we established and the Conservatives opposed. We are investing extra money in the health service. The Conservatives opposed that. Those are the results of the choices that we have made.

On intensive care beds, the hon. Member for Woodspring (Dr. Fox) will find that this winter there are more intensive care beds than there were last winter. We allocated a further £150 million, and I expect there to be substantially more than 300 extra critical care beds.

On bed blocking, the rate of delayed discharges is falling, certainly from the level that we inherited from the previous Government. As for the number of beds, the hon. Gentleman is aware that yesterday I announced the third wave of major hospital redevelopments. Many of those will be built as part of the private finance initiative. I have also stipulated that in the third wave, the 18 major new hospitals should help to increase the number of hospital beds, thereby helping to reverse a 30 or 40-year trend of decline.

The hon. Gentleman knows that the point that he made about Professor Mike Richards, the cancer tsar, is wrong.

On waiting times, the report published yesterday is factually inaccurate. The same company produced a report last summer. It was factually inaccurate then; it is factually inaccurate now.

Several hon. Members


Mr. Milburn

I still have more inaccuracies to relate to hon. Members.

The hon. Gentleman's most serious factual inaccuracy was at the beginning of his remarks. He said that the Conservatives would match Labour's record levels of health investment, but they cannot. We have made our choice. We chose to invest more in the health service. They have made their choice, too. They chose not to vote with us when we wanted £400 million-worth of extra tobacco revenue to go directly to the national health service. Just today, the hon. Gentleman is choosing to use £500 million which could have gone into the NHS to subsidise people with private health insurance.

The Conservatives cannot match us on health service expenditure. Indeed, their programme of cuts would result in £900 million less for local health services—the equivalent of £9 million less for every health authority in the country. That is the Tory guarantee on health: £9 million-worth of cuts in every local health service in the land.

Several hon. Members


Mr. Speaker

Order. I want to call as many hon. Members as possible, so I ask for questions to be brief.

Mrs. Alice Mahon (Halifax)

On behalf of the people of Calderdale, who will receive an 8.6 per cent. increase in funds, I thank my right hon. Friend for today's announcement. He will know how we suffered under the previous Government's funding. We are delighted that we have a new hospital and will receive the increase.

Will some of the money that has been allocated be targeted on the elderly who, with the right care package, could be cared for at home instead of taking up hospital beds that they do not need and which add to the problems?

Mr. Milburn

I am grateful for my hon. Friend's comments, and I can give her that assurance. When we publish details next month of the roll-out of the NHS plan, she will see that it includes commitments to improving elderly care services. We need to ensure that we get rid of some of the perverse incentives and end the practice that puts all elderly people in care homes when they want to stay at home. We can do that by ensuring that there is more co-operation between health care and social care services, by taking advantage of the flexibilities under the Health Act 1999 and, most importantly, by providing the extra investment that we are making in the health care and the social care systems.

Mr. Nick Harvey (North Devon)

I welcome the additional money for the health service and the useful innovation of three-year budgeting, but will the Secretary of State confirm whether the new cost of living supplement for key staff is over and above the forthcoming annual pay review? Until we have seen the figures awarded in that review, is it not difficult to assess what the impact will be on each health authority area as it tries to tackle the many targets that the Government set in the national plan and, indeed, again today? Is there a hierarchy of targets?

The Government are committed to providing free nursing care from halfway through the financial year, which is mentioned in today's settlement. How will that money be channelled? Will it go through social services or are we to assume that it is in the budget figures that we have been given today? If so, how can we quantify that?

We have been told that NICE is the solution to postcode prescribing. Will the Secretary of State confirm that the funds to implement all NICE's recommendations over the coming year at local authority level are included in today's figures?

Finally, may I express my regret at hearing that a review of the formula is still some years away? In Scotland, sparsely populated rural areas are already being recognised as having special needs; in Wales, that is coming. I hope that the situation in England will be remedied a great deal sooner than over the next few years.

Mr. Milburn

I am grateful to the hon. Gentleman. We will see what we can do on the formula, but believe me, I and previous Secretaries of State who are present in the Chamber have wrestled with the intricacies of the formula. Trying to get the money to the right areas is like a game of three-dimensional chess. We must make sure that, rather than tinkering, as has been the case in the past, we have a fundamental root and branch review of the formula. That is the right thing to do. It is also the right thing to do in conjunction with the local government review that colleagues elsewhere in Government are undertaking.

On the cost of living increases for nurses, PAMs—professions allied to medicine—midwives and others, I can confirm that the cost of living increases are over and above what the review bodies will recommend. That is the right thing to do, and it is plain common sense that some parts of the country, largely in London and the south-east, have a higher cost of living than elsewhere. If we are to do what we need to do to tackle shortages of nurses, therapists and so on, we must provide extra financial incentives for staff through their pay packets. That is what we will do.

On free nursing care, yes, I can confirm that at present the money is in health authority budgets. I can also confirm that it is our intention, subject to Parliament, to introduce free nursing care part way through the next financial year.

Finally, on the National Institute for Clinical Excellence, we must make some provision, of course, for an increase in drugs expenditure. As I have said before in the House, if we can get good, high-quality, cost-effective and clinically effective drugs to more and more patients, I have no problem with drugs expenditure increasing, and increasing above the level of general health authority allocations.

Mr. Robin Corbett (Birmingham, Erdington)

There will be a noisy welcome across Birmingham and the west midlands for the heavy extra investment in the health service there, not least among the too many people waiting far too long for cardiac care and treatment. Will my right hon. Friend require health authorities to publish the extra allocations to hospitals in their area and the purposes for which that money is given, and also require hospital trusts to report on how they have performed with the money given for those specific purposes, so that we can all monitor, publicly and together, what is going on in the health service?

Mr. Milburn

I am grateful to my hon. Friend. It is one of the deals on offer that in exchange for the extra investment that we are putting into the health service, we must see, in as open and accountable a fashion as possible, improved performance. Of course there will be a lot more measuring. We should measure what is going on in the health service.

We cannot have our cake and eat it. We cannot, as some do, decry the lottery in care and different standards in different areas, yet do nothing about it. It is the right thing to do to make sure that we monitor and account, as a local health service, for the services provided to local communities. I can therefore confirm that we will want much more openness and transparency, not only in the way cash is allocated within a local health authority area, but most importantly of all, the progress and the reforms that we get back for the resources that we are investing.

Mr. Kenneth Clarke (Rushcliffe)

I welcome the extra money targeted towards Nottingham, which will bring us closer in line with our health needs. I also welcome the Government's reversion to the previous Government's policy of targeting waiting times, as opposed to the numbers on waiting lists, which has done so much damage in recent years.

Is the Secretary of State promising not to return to the bust and boom in health expenditure which characterised the first years of Labour? He knows that the present crisis was caused by his Government forcing on his predecessor as Secretary of State a cancellation of the annual spending reviews, in which we had always raised health spending in line with needs and events. If the last year of the previous Parliament was a bad one, all the more shameful, then, that the present Government cancelled the annual spending increases for the first two years of their term.

Now that the right hon. Gentleman has an increase for next year which matches the increase that I was able to announce as Secretary of State in 1990, is it wise to set it so firmly in stone for three years, expressed in cash terms to make it sound bigger? Is there a let-out clause to allow the matter to be reopened if inflation pressures and the course of events prove that necessary, in order to keep the health service on course and to recover from the neglect of the first three years of Labour?

Mr. Milburn

I am grateful to the right hon. and learned Gentleman for his comments, particularly his welcome for extra money for Nottingham, which, as I remember, is one of the big gainers from the allocations that we have made today.

Mr. Dennis Skinner (Bolsover):

A lot more than when the right hon. and learned Member for Rushcliffe (Mr. Clarke) was Secretary of State.

Mr. Milburn

Correct. The right hon. and learned Gentleman touched on his record, but I remind him that, when he was Chancellor of the Exchequer, the increase in net NHS expenditure in 1995–96 was 1.6 per cent. in real terms, and in 1996–97, the final year, it fell by 0.1 per cent. So if the right hon. and learned Gentleman does not mind, we will have fewer lessons from him.

The right hon. and learned Gentleman knows fine well that there is a direct relationship between the number of people on the waiting list and the length of time that they wait for treatment. I bet that, when he goes to Sainsbury's or Tesco—or he may even be a Co-op man for all I know—he always joins the shortest queue at the checkout.

Laura Moffatt (Crawley)

I thank my right hon. Friend for his welcome news for trusts, particularly in my area. They will heave a great sigh of relief at now being able to recruit in the way that they wish. My right hon. Friend knows that modernisation, not just investment, is the key to our NHS moving forward. With regard to improving treatment for cardiac patients, has my right hon. Friend given any thought to allowing paramedic ambulance crews to give the so-called clot-busting drugs? As my right hon. Friend said, it is so important for those to be given as quickly as possible. Has my right hon. Friend made any movement on that?

Mr. Milburn

Yes, I can confirm that. During the next few months and in the next financial year, we shall start to do precisely that, ensuring that, in future, more and more paramedics are appropriately trained to give those life-saving drugs to people who have had a heart attack. It is far more sensible to do that immediately the ambulance arrives at someone's home rather than having to transport the heart attack victim from home to hospital, with all the delays that can accrue.

Mr. Simon Burns (West Chelmsford)

When the Secretary of State talks about real-term increases in funding, he rightly bases that on the retail prices index. But as the right hon. Gentleman will be more than aware, NHS inflation and wage inflation are significantly higher than the RPI. Has he calculated what impact NHS inflation will have on his spending plans during the next three years and how it will affect NHS spending?

Mr. Milburn

Yes, we have done that. I can confirm that, while the cash rise is, on average, 8.5 per cent., the real-terms rise is about 5.9 per cent. The hon. Gentleman will be aware that, as when the right hon. and learned Member for Rushcliffe (Mr. Clarke) held office, it is well in excess of the amount of money made available to the NHS when he, I think, was a Health Minister.

Helen Jones (Warrington, North)

I welcome what my right hon. Friend has said, particularly with regard to the performance fund, some of which I hope will come to Warrington hospital in due course. Will my right hon. Friend ensure that, in his review of funding, the needs of areas such as north Cheshire, which has large pockets of health inequalities among areas of affluence, particularly in my constituency and that of my hon. Friend the Member for Halton (Mr. Twigg), are met, so that they can tackle the health inequalities that exist outside big cities?

Mr. Milburn

Yes; I do not know whether it was made clear to my hon. Friend in the letter that she received from me today, but I can confirm that, in the allocation to North Cheshire health authority, there is a health inequalities adjustment of an extra £1.1 million, precisely recognising the real health problems of her area and others.

Sandra Gidley (Romsey):

It would be churlish not to welcome extra money, and I particularly welcome the cost of living allowance for health professionals, but I represent a Hampshire constituency and I did not hear Hampshire mentioned in the list. Will the Secretary of State please confirm the situation with regard to Hampshire?

Mr. Milburn

The following health authorities, which—helpfully—are not ranked in alphabetical order, gain from the cost of living allowance: Southampton and South West Hampshire, Portsmouth and South East Hampshire and North and Mid Hampshire. It is good to make someone happy.

Dr. Ian Gibson (Norwich, North)

I thank my right hon. Friend for granting resources for Norfolk, but I especially welcome the fact that the resources are to be spread throughout the country. That is an important political point. I have known my right hon. Friend for many years through our days in the Association of Scientific, Technical and Managerial Staff. I never imagined that he would become the man with the team that cracked the postcode lottery. Today's announcement means that he has done that. Thank goodness the right party won the election in 1997; it is a shame that we did not win in 1992. Some of us might have enjoyed our jobs in cancer research in the intervening five years much more than we did.

Will my right hon. Friend confirm that the money is separate from the money for radiotherapy machines and buildings that has always existed? Today is a heyday in the fight against cancer and for the medical world in general.

Mr. Milburn

I am grateful to my hon. Friend, and for all his work for cancer research and in the battle against cancer. I can confirm that the extra money will be for revenue purposes. I shall make announcements in due course about extra capital. Without letting too many cats out of the bag, we expect further improvements and investment in the modernisation of cancer equipment. That is long overdue; it is desperately needed and, as my hon. Friend rightly said, it should have started many years ago.

Mr. Andrew Rowe (Faversham and Mid-Kent)

As the Secretary of State knows, I am especially glad that cancer is beginning to get the sort of priority that it deserves. However, he knows that some nursing agencies on which the NHS depends have been recruiting staff in sub-Saharan Africa. Does he believe that robbing the poorest countries in the world to improve our health service constitutes proper use of the money that has been put into the NHS?

Mr. Milburn

No, I do not. Sadly, I do not run the nursing agencies that are responsible for such conduct. However, as the hon. Gentleman knows from the NHS plan commitments, we will recruit some staff from overseas, for example, nurses from Spain. We shall also attempt to recruit some doctors from other parts of Europe. However, we do not believe that we should rob developing nations of the medical and clinical staff that they desperately need.

Mr. Tony Lloyd (Manchester, Central)

My right hon. Friend's remarks, especially about Manchester, gave a clear signal of the Government's commitment. One of the biggest blots on the NHS in recent years has been the relationship between poverty and ill health.

Earlier, my right hon. Friend mentioned "la, la", sitting opposite. There were no kindly Tory Teletubbies in previous Governments; instead, there was indifference to and cynicism about health inequality. Every Manchester Labour Member beat a path to successive Tory Health Ministers and were told that inequality did not matter. Today's announcement means that my constituents can look forward to the same quality of health care as those of Conservative Members. That is a genuine sign of proper commitment to a fair and universal national health service.

Mr. Milburn

I am extremely grateful to my hon. Friend. I agree with the thrust of his remarks. We all know from our constituencies, regardless of whether we represent a so-called poor area or a so-called rich area, that there is a clear correlation between poverty, deprivation, poor housing, lack of employment opportunities and ill health. Frankly, the position is worse than my hon. Friend suggested. Not only did that lot refuse to recognise inequality: they banned the word in the Department of Health.

Mr. Julian Brazier (Canterbury)

At a time when there have been patients, some with serious conditions, on trolleys and in offices in all three acute hospitals in east Kent, and when many of our roads and our rail system have been disrupted by flooding, is the Secretary of State aware of the dismay with which people continue to face the proposed reorganisation in east Kent? It includes closing the accident and emergency unit in the heart of east Kent, stripping the Kent and Canterbury hospital, to whose coronary and cancer units the Secretary of State is committed, of many of its supporting services, and funding the process by a cut in beds in that overstretched hospital.

Mr. Milburn

I am not particularly surprised by the hon. Gentleman's comments, although I am somewhat disappointed. He should welcome the 8.44 per cent. increase in funding for the health service in his area, because it will help to deal with some of those difficulties. Just because we are putting record levels of investment into the national health service, it does not mean that the health service at a local level will not change. Medical advances, changing technologies and changes in demography are all driving change in the national health service. It has changed over the past 52 years, and it will continue to change over the next 52. Rather than stand in the face of change, the hon. Gentleman should get on side and support the changes to ensure that his constituents get better care than they have received in the past.

Mr. Eric Illnsley (Barnsley, Central)

My right hon. Friend's announcement will be most welcome in the Barnsley health authority area, especially in view of the inequalities in health care in that authority in the past. As my right hon. Friend knows, historically Barnsley is one of the lowest-funded health authorities in the country, yet it has some of the greatest needs in the treatment of cancer, strokes and heart disease. Will my right hon. Friend give me some reassurance that the needs of our health authority will be met by closing the funding gap and bringing us closer to our target funding in future years?

Mr. Milburn

We have increased the funding for Barnsley health authority by 8.7 per cent., which is an increase of just under £15 million. That will help to address some of those very real health problems. As the local constituency MP who is very active on health issues, my hon. Friend will know that some of these problems are pretty intractable and structural, and it will take time to deal with them. That is why it is important that we get an appropriate level of health service expenditure into the local NHS, and that we sustain that funding over a period of years. It is terribly important to do what we have done today, which is not just to make available a one-year allocation, but to give health authorities a sense of where they will be in two or three years' time.

Mr. David Heath (Somerton and Frome)

I, too, welcome the extra spending. I want to return to the point made by the hon. Member for Crawley (Laura Moffatt). I presume that the welcome target that the Secretary of State has announced for administering thrombolytic drugs is within 30 minutes from the point of arrival at accident and emergency units. In my constituency and in much of the west country, it can take twice that long to get from the scene of the event to the accident and emergency unit, partly because of the distances involved and partly because of the overstretched ambulance service and the lack of air cover. Will he consider precisely how drugs and treatment can be administered at the earliest possible point for people who live in rural areas that are not easily reached by ambulance crews?

Mr. Milburn

The hon. Gentleman makes an extremely good point. It is self-evident that it is far more sensible, especially in rural areas, to take the drug to the patient than to expect the patient to travel to the drug. We need to do both. We need to improve the time that patients have to wait in accident and emergency departments to be given thrombolysis, and we also need to ensure that more and more paramedics are trained so that they can administer the clot-busting agent on the spot.

Ann Keen (Brentford and Isleworth)

I welcome my right hon. Friend's statement, and it will be very welcome to my constituents and to people in west London. So as to bring senior nurses back into the health service, has my right hon. Friend considered the senior clinical nurses who were evicted overnight from sites around the country and who went into higher education, which is what nurse education should be in my opinion? We should find ways of using their clinical expertise and knowledge, and perhaps give them joint roles in the health service. Many of those clinical leaders are now stuck in higher education and do not have the same right to enter hospital sites and hospital trusts.

Mr. Milburn

I am grateful to my hon. Friend, who is extremely knowledgable about these issues. I agree with her that we must provide the right incentives, the right education and training and the right employment opportunities to ensure that we not only recruit more nurses back into the NHS, but retain them once they are working for the health service. We cannot have more nurses coming back into the service and an excess of nurses leaving it. We are moving in the right direction. We are turning the corner: there are now more nurses working in the NHS than there were just a year or so ago, but there is a lot more work to do.

With regard to nursing careers becoming more academic, we must get the balance right. We must give nurses who will become nurse consultants and operate at a high clinical level appropriate academic training, but we must not lose the fundamental caring nursing skills that are the backbone of the nursing profession.

Mr. Roger Gale (North Thanet)

I welcome the 8.4 per cent. increase that has been re-announced for east Kent. By January slightly more, not fewer, beds would have been available in east Kent, but they will not be available because they will be blocked. Nothing that the Secretary of State has said this afternoon will change that.

Broomfield Lodge nursing home in my constituency is one of Kent county council's preferred providers for the elderly and senile, but because it is underfunded by about £100 to £150 per week per client, and because it is competing with NHS agencies for nurses in terms of costs, it is likely to close. If it does, the 18 clients who are there now will join the others who are blocking beds in hospitals, and add to the problems caused by the loss of 200 beds in the private nursing sector until April. There is nowhere for those patients to go this winter. What are the right hon. Gentleman and the Secretary of State for Social Security going to do about it?

Mr. Milburn

I am grateful to the hon. Gentleman for giving at least a modicum of welcome to the extra resources provided for his health authority area. As for delayed discharges and the position in the care home sector, it is true that there are problems in some parts of the country. That is largely a product—especially in the south-east—of rising property prices, and of people getting out of the business because—

Mr. Philip Hammond (Runnymede and Weybridge)

Because of the Care Standards Act.

Mr. Milburn

It has absolutely nothing to do with the Care Standards Act 2000, as the hon. Gentleman knows fine well. We have given care home owners seven years in which to introduce the new standards. The idea that they are suddenly walking away from their businesses today is ludicrous.

As I have said, there are problems in some parts of the country. That is precisely why social services departments—I hope this applies to the area represented by the hon. Member for North Thanet (Mr. Gale); if it does not, perhaps he will take up the matter with Conservative-controlled Kent county council—have increased the number of intensive home care packages of support in order to provide people with more care at home this winter than was provided last winter. Moreover, social services expenditure, which rose by an average of 0.1 per cent. under the last Government, has been rising by 3.1 per cent. over the past few years.

Mr. Paul Flynn (Newport, West)

The Secretary of State is gradually giving real hope to all who use the health service that intractable problems will now be tackled. One such problem, in regard to which this country has performed very badly, is the huge number of hospital-acquired infections. What will the Secretary of State do to tackle that? It is claimed that up to 5,000 deaths a year arise from hospital-acquired infections. That leads to a huge waste of resources because patients are staying in hospital beds for much longer than would otherwise be necessary. The problem has been tackled with great success in the Netherlands—when can we follow its example?

Mr. Milburn

My hon. Friend is right. Although we are making a lot of money available to the NHS, and although the NHS has a clear reform programme and a good deal of commitment to making changes, real and intractable problems nevertheless exist.

There is no quick-fix solution to the problems of the NHS. The issue of hospital-acquired infection is very serious: as my hon. Friend says, it affects many patients, and it also costs the taxpayer a pretty penny. That is why the Minister of State, Department of Health, my hon. Friend the Member for Southampton, lichen (Mr. Denham), recently issued clear guidance to all NHS hospitals saying that they must improve their standards of cleanliness and decontamination.

I can tell my hon. Friend that we intend to publish all the standards reports that we receive from hospitals by April next year, so that the public can see the progress we are beginning to make. It will not be easy, however, and it will take some time.

Mr. Paul Burstow (Sutton and Cheam)

Will the Secretary of State comment on reports in yesterday's Evening Standard that winter pressures now appear to be becoming autumn pressures in Greater London? Already people have been exported from Greater London because no intensive care beds are available, and because there are still not enough intensive care nurses. Can the right hon. Gentleman assure us that we shall have extra nurses this winter, so that we do not experience the same crisis in London that we experienced last year?

Mr. Milburn

To say that the figures that were quoted in yesterday's Evening Standard are evidence of a crisis is fundamentally misleading. The number of intensive care transfers is slightly down compared with the same period last year, and the figures have fallen since September this year. I hope that the hon. Gentleman will not fall into the same trap as the official Opposition—they are looking for, and are determined to foment, a winter crisis. Indeed, they are determined to declare war on the national health service this winter. I hope that he realises that there are people—and newspapers—in this country, and some Members of Parliament, who are no friend of the NHS.

Mr. Jonathan Shaw (Chatham and Aylesford)

Tomorrow I will meet primary care staff in my constituency. I am sure that they, like me, welcome the extra cash for the west Kent health area. In tackling some of the inequalities that my right hon. Friend mentioned, especially in respect of mental health and coronary heart disease, does he agree that it is essential for primary care trusts to identify the people at the greatest risk in a community? In his next announcement on capital expenditure, will there be an allocation for investment in information technology? Such preventive measures require primary trusts to have access to good IT in order to carry out that essential work.

Mr. Milburn

My hon. Friend is right on both counts. All parts of the primary care system require improvements in IT infrastructure, which has suffered from under-investment. Parts of the health authority allocations are specifically for improved IT in GP surgeries and hospitals.

My hon. Friend will be aware from the NHS plan that we want primary care to involve GP surgeries and health care centres in establishing at-risk registers to identify those patients who have had, or are liable to have, a heart problem. As he knows, some fairly simple, cost-effective treatments can be made available to such patients. They are far more effective and better than people having a heart attack before going to hospital for a serious operation.

Mr. Peter Lilley (Hitchin and Harpenden)

Can the Secretary of State explain why, despite Labour's promises, mortality rates—the number of people dying within 30 days of emergency treatment—in four out of five hospitals surrounding my constituency are no lower than during the last year of the previous Conservative Government? Will he also confirm the National Audit Office figures that showed that nearly one in 10 NHS beds is occupied by a person who acquired his infection or complication while in hospital, as the hon. Member for Newport, West (Mr. Flynn) suggested? If the right hon. Gentleman could solve that problem, would that not relieve human suffering and release far more resources than he announced today?

Mr. Milburn

I am grateful—just about—to the right hon. Gentleman for his comments. For the first time, we have infection control teams in hospitals up and down the country. We established them, not the previous Government. Frankly, is not the idea that hospital-acquired infection suddenly broke out on 1 May 1997 rather laughable?

Mrs. Anne Campbell (Cambridge)

I warmly congratulate my right hon. Friend on his statement and on yesterday's announcement of £22 million for Addenbrooke's hospital, which will help my constituents. Does he agree that the 32 extra beds that that £22 million will achieve will mean shorter waiting times, and that that would be put at risk if a Tory Government were ever re-elected because they prefer tax perks for those with private medical insurance?

Mr. Milburn

My hon. Friend is right on both counts. We are now in a position to reverse a decline in the number of acute and general beds in hospitals, which has been occurring for many—perhaps 30 or 40—years. As I have told the House before, my view is that we must increase the number of hospital beds and beds in the whole care system if we are to provide the quality of care and the speed of response that patients rightly expect nowadays. She rightly said that all that investment would be put at risk thanks to the cuts guarantee that the Conservative party has, in effect, now published. It would take £9 million from every health authority in the land. Conservatives must explain that to their constituents; I am sure that my hon. Friend will explain it to hers.

Dr. Peter Brand (Isle of Wight)

I should like an assurance from the Secretary of State that all the money in the performance fund will be spent. Are there any moneys outstanding in this year's performance fund allocation? Does he recognise that some health authorities cannot perform because they cannot attract the necessary staff and have to rely on extremely expensive agency locums? That is a tremendous disadvantage to health authorities, such as the Isle of Wight.

Mr. Milburn

The Isle of Wight will do rather well as a consequence of some of the changes that I have made today. The hon. Gentleman lives in hope; I live in hope that he will see the light eventually. The performance fund will be fully spent. It is important to make it clear that the idea is that each and every part of the local health service will get its fair share of the performance fund. However, the poorer performers will inevitably have strings attached—of course they will; that must be right. If they have not come up to scratch, most right hon. and hon. Members would be pretty wary of spewing yet more resources into them without conditions being applied.

There are problems with agency nurses, but the hon. Gentleman knows that, on Friday, the Prime Minister announced our proposals to ensure that the NHS gets to grips better with precisely those problems, so that we improve the quality of care for patients and the value for money for taxpayers.

Mrs. Louise Ellman (Liverpool, Riverside):

How much has been allocated to addressing health inequalities in Liverpool? My constituency has been identified as the second poorest area of the country and the one suffering the worst ill health. How will my right hon. Friend ensure that the money allocated is targeted at the areas of need already identified in Liverpool by the performance indicators published earlier this year, so that it specifically addresses the issues of too few general practitioners, the shortage of staff to undertake cancer screening and the high levels of heart disease and emergency hospital admissions?

Mr. Milburn

I am grateful to my hon. Friend for her comments. Liverpool will receive an extra £4.3 million as a health inequality adjustment within its health authority allocation this year, precisely to take account of some of the very real problems that she describes. However, it is not just a matter of getting the money into those areas; we must also ensure that we get the services and the staff into the inner cities. She is aware that because of how we have distributed GPs around the country in the past, we have not always met need in primary care in the way in which we should. That is precisely why we are rolling out a big expansion in the number of personal medical services GPs, and I expect that next year a substantial proportion of those will go into precisely the areas that she describes, where they are most needed.

Mr. Michael Howard (Folkestone and Hythe)

I welcome the emphasis that the Secretary of State places on the treatment of heart disease and on dealing with waiting times. Is he aware that, in east Kent in July, 108 people had been waiting more than three months for heart surgery—the comparable figure for March 1997, about which he was so scathing, was 63—and that 207 people had been waiting more than 13 weeks to see a cardiologist—the comparable figure for March 1997 being 40? Is he not thoroughly ashamed of those figures? What assurances can he give my constituents that things will not get even worse this winter?

Mr. Milburn

As the right hon. and learned Gentleman is aware, for the first time the Government have made available earmarked funding precisely to tackle some of the problems in heart surgery rates that we inherited. The previous Government did not make a penny piece available for earmarked heart surgery; we have done so. During the next few years, there will be 3,000 extra heart operations, a further 3,000 extra heart operations, and, over time, as we expand the number of heart surgeons, waiting times for treatment will come down not just in his area, but throughout the country.

Ms Hazel Blears (Salford)

My right hon. Friend's statement will be welcomed by people in Salford. It is real evidence of the Government's commitment, and indeed my right hon. Friend's personal commitment, to tackling health inequality. I find the Opposition's last-minute, deathbed conversion to redistribution singularly unconvincing, but we wait to see the evidence of what they have said.

I know that my right hon. Friend recognises that the causes of inequality are complex and that the NHS acting alone cannot resolve all the problems. Will he ensure that the extra investment is worked on with partners in local government and in the voluntary sector to ensure that we get added value from the extra resources that we put in, and that we monitor closely the outcomes that we achieve? The extra money must make a real difference to our communities.

Mr. Milburn

I very much agree with my lion. Friend. As she recalls, a year or so ago I visited parts of her constituency where there is deprivation and associated pockets of ill health. She is right that the job of tackling health inequalities and improving life chances for people is not just the job of the NHS—it must be done in concert with local government, local organisations and, most important, local communities. That is precisely what we are seeking to do through the local strategic partnerships that the Government are seeking to create.

Mr. John M. Taylor (Solihull)

Will the Secretary of State confirm that there may be many instances when it makes sense for the NHS to contract services to the private health sector, not least because that sector has lower unit costs? If he has come to that conclusion and is prepared to do that, may I congratulate him?

Mr. Milburn

I am not sure about the issue of unit costs; that will have to be hammered out on the ground between the local health service and the local private sector provider.

As I have made clear before in the House, I have no problem with the NHS contracting with private sector providers to ensure that NHS patients receive treatment for free and in as timely a way as possible. However, there are two important caveats: we must be assured that we are getting the highest standards of care for patients and the best value for money for taxpayers.

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

I thank my right hon. Friend for doing something about all the years of underfunding in the NHS. My constituents will welcome his statement. They will want to see a shift to primary care, and they will want to know that there will be the necessary training for the extra personnel that we need.

The North Stoke primary care trust in north Staffordshire is £4 million away from its target and there are huge health inequalities. Can my right hon. Friend give us some hope that those health inequalities in north Staffordshire are at last being addressed?

Mr. Milburn

I am grateful to my hon. Friend, who makes a very good point. We have a fairly blunt instrument at the moment for distributing cash to local parts of the NHS—the local health authorities—but, from the points that she has made, she is aware that, within a health authority, there will be pockets of deprivation alongside pockets of prosperity. That is why we will suggest to health authorities that, for the next financial year, they get the appropriate pace of change in place to ensure that the resources are in place at a very localised level, as we have sought to do in distributing cash from national to health authority level.

Mr. Tony Baldry (Banbury)

Is the Secretary of State aware that last week an orthopaedic surgeon at the general hospital in Banbury told me that he does not expect to carry out any elective surgery until February at the earliest because of a shortage of nurses and beds, because surgical beds are being taken up by medical cases, and because beds are being blocked by people who need to move back into the community, but for whom community care is not available? We will not reduce either waiting times or waiting lists until surgical beds and surgical services are in some way protected.

Mr. Milburn

It is true that the previous Government closed a lot of those beds, but it is also true that the hon. Gentleman has a good point. There are problems in Oxfordshire precisely because of the cost of living difficulties of which he is all too painfully aware, which sometimes make it difficult to recruit staff. That is precisely why, within Oxfordshire's health authority allocation, we have made extra money specifically available for his area to allow it to recruit the nurses and PAMs that are so important in a clinical team working alongside the doctors.

There is another trick that we must perform. The hon. Gentleman is right that, this winter, the national health service will do what it should sensibly do: prioritise emergency cases. Obviously, the emergencies must come first, but that will mean that we will free up some elective capacity, particularly in the form of surgeons—ear, nose and throat surgeons, for example. Frankly, if we can get those people working in private sector hospitals to provide care for free to NHS patients, it would be making the best use of available staff and capacity. I am sure that that is what the hon. Gentleman will see in his area and what we will see in other parts of the country.

Mr. Derek Twigg (Halton)

I welcome the statement, particularly the announcement of extra cash and the three-year plan, which will be very important for health authorities to plan properly. My right hon. Friend knows from representations made by me and my hon. Friend the Member for Weaver Vale (Mr. Hall) that the situation in Halton in relation to all types of cancer and coronary disease is the worst in the country. I therefore welcome his announcement that £1.1 million is being earmarked to deal with the special problems in north Cheshire. It is also about time—I am pleased that my right hon. Friend is doing it—to review the NHS funding formula which has discriminated against my constituents, who deserve more resources. I welcome the review, and I hope that it is conducted very quickly.

Mr. Milburn

As I said, extra money is available specifically for tackling the problems in my hon. Friend's own area as part of the fairly large 8.6 per cent. funding increase for the North Cheshire health authority. It is very important that right hon. and hon. Members on both sides of the House understand that it will take time to achieve all the objectives. Although we are dealing with very large numbers—historically, the increases are very large indeed—we are also dealing with some very large problems and a very large inheritance of under-investment and neglect over many decades.

Mr. Michael Fallon (Sevenoaks)

The Secretary of State has to determine the average funding increase for mental health services arising from the allocations that he has announced today. Does he recall that, two years ago, I and my hon. Friend the Member for Tunbridge Wells (Mr. Norman) and others came to see him about the case for a single-site hospital in west Kent?

Mr. Milburn

I am very aware of the case for a single-site hospital. As the hon. Gentleman knows, the hospital and the regional office will be able to submit their proposals again in the third wave of the major hospital building programme that I announced yesterday. I expect to make decisions on that early next year, and to be able to make some announcements on it in the spring.

Several hon. Members


Mr. Speaker

Order. I have allowed the statement to continue for more than one hour and 10 minutes, and we must move on. I regret that some hon. Members have not been called, but I shall take a note of their names.