HC Deb 15 February 2001 vol 363 cc467-82 1.11 pm
The Secretary of State for Health (Mr. Alan Milburn)

With permission, Mr. Speaker, I wish to make a statement on the NHS hospital building programme.

The national health service is in the most prolonged period of expansion in its history. The NHS plan that we published last July set out a major reform programme to accompany the investment that we are making. Extra cash is now beginning to bring on line the extra capacity that the NHS needs to make care better and faster for patients.

This morning, my Department published new figures showing continued growth in qualified staff within the health service. The figures show that in September 2000, compared with September 1999, there were 2,500 more doctors, 3,500 more scientists, therapists and technicians and more than 6,300 more nurses working in the NHS. That means that since 1997, the number of doctors has risen by 6,700, the number of scientists and therapists by 9,600 and the number of nurses by 17,100. Of course, problems do remain with shortages of doctors, nurses and other trained staff, but progress in the health service is now being made.

The NHS plan set ambitious targets for addressing the shortage of trained staff that has bedevilled the NHS for many decades. From April. NHS budgets for training doctors, nurses and other qualified staff will rise by over 11 per cent. Together with the other action that we are taking to recruit and retain more staff, that increase in training budgets will sustain growth in staff numbers not just until 2004, as the NHS plan promised, but until 2010. The record increases in funding which the Government are now making mean that the NHS today is the fastest growing health service of any major country in Europe.

There is a huge amount of catching up to do. Nowhere is that clearer than in the state of NHS buildings. This afternoon, I am publishing a report on the progress that we need to make as a nation in improving the NHS estate and, in particular, in modernising its hospitals. One million patients a week use NHS hospitals. One third of those hospitals were built before the NHS was created, and one tenth date back to Victorian times. We cannot deliver 21st century care in 19th century buildings.

For too long, investment in NHS infrastructure has been a low priority when it should have been a high priority. Capital investment in the NHS was lower at the end of the previous Parliament than it was at the beginning. The consequences are plain for all to see: shoddy buildings, unreliable equipment and out-of-date hospitals. In too many places, the environment in which staff work and patients receive care is simply unacceptable.

We have made a start in putting that right. The biggest new hospital building programme in the history of the NHS is already under way. Since 1997, 38 major capital schemes, worth almost £4 billion, have been given the go-ahead. New hospitals are already open in Carlisle, Dartford, south Buckinghamshire, Rochdale and Sheffield. A further five new hospitals are due to open later this year.

The NHS plan set out proposals for a total of 100 new hospital developments in England during the course of this decade. Many parts of the country need those new hospitals—some local communities have been waiting decades for them. In 1997, we established a team of experts—the capital prioritisation advisory group—to advise the Government on which new hospitals should move ahead first. The criteria that the group uses includes an assessment of w here health need is greatest and facilities are poorest.

The group has met during the past few months to advise on the next round of new hospital developments. I am grateful to it for the difficult work that it has had to do. The NHS plan indicated that nine new hospital developments would be given the go-ahead in 2001, with a further nine to follow in 2002. The group considered 29 bids for those 18 new hospital developments. The advice that I have received is that there is a strong case for investment in all 29 proposed schemes. I have accepted that advice. Instead of approving 18 schemes, I am giving the go-ahead to all 29.

I can announce that, during this year, work will begin to procure 12 new hospital developments in Birmingham and Bradford, for Bristol's mental health services, in Central Middlesex, East Kent, Leicester, Lewisham, Peterborough, Salford, Tunbridge Wells, Wakefield and Whipps Cross. Next year, work will begin to procure a further 13 new hospital developments in Brighton, for Bristol's acute services, in Central Nottinghamshire, Chase Farm, Chelmsford, Colchester, Hull, North Middlesex, North Staffordshire, Plymouth, St Helens, Walsall and Wolverhampton. The following year, work will begin to procure a further four new hospital developments in 0xford, Southampton, South Devon and Tameside.

The total projected value of the new hospital developments is £3.1 billion. Each will need to be subject to the normal approvals process and, of course, each will need to confirm viability, affordability and value for money before it is flu ally signed off. The first of the new hospitals will be open by 2006. That is an unprecedented expansion in new hospital developments in the NHS. For millions of patients and thousands of staff, it will provide modern state-of-the-art hospital treatment and care.

Many of the new hospital developments will be delivered through the private finance initiative, if that represents best value for the taxpayer and the NHS. I can confirm that, at the end of the PFI contract, the option will he open for each hospital to become the property of the local health service.

I am also making a further major reform of the PFI process. For too long, hospital developments have been considered in isolation from other changes to local health services. A hospital can only work successfully—for example, avoiding bed blocking and long waiting times—if it works in partner Chip with local primary, community, intermediate and social services. In each of the PFI deals, consideration will need to be given to building alongside a new hospital new primary and intermediate care facilities in the local community to help to ensure more seamless care for local patients. In some cases, that has already happened, spreading the benefits of private finance to other pares of the NHS, where investment is sorely needed.

However, we need to go further still if we are to deliver the shorter waiting times that patients need and good health demands. NHS hospitals deal with almost 4 million emergency admissions a year. They have grown by more than one quarter in the past 10 years. In the NHS, emergencies always come first. That is as it should be, but every year increased emergency admissions displace planned elective admissions. That sometimes means that planned operations are cancelled at the last minute, causing distress for patients and frustration for staff.

The NHS plan announced a new generation of diagnostic and treatment centres to overcome that problem by separating emergency from elective work. Today, my right hon. Friend the Prime Minister is visiting one such pioneering centre at the Central Middlesex hospital. As its experience shows, insulating routine hospital operations from often more complex emergency treatment can make a real impact on the time that patients wait for treatment.

Within the hospital developments that I have announced, 16 such new centres will be developed. In addition, similar projects have been agreed at City Birmingham hospital, Dudley, Hinchingbrooke, Kidderminster, Liverpool, Milton Keynes, Ormskirk, Southport, Sutton Coldfield and West Middlesex. In total, we shall invest around £250 million in this new generation of fast-track surgery centres.

The centres will each have distinctive features according to the needs of the local health service, but they will all bring faster care to patients. Patients will be able to book their admissions at their convenience rather than simply being given an appointment time. Some centres will operate at weekends. There will be more day surgery and more same-day test and diagnosis. They will all help to get waiting times down for patients. Crucially, they will mean greater reliability for patients by helping to end the misery of last-minute cancelled operations.

Investment in new hospitals must produce reform in the way in which hospitals deliver care. The problems that patients and staff experience today in the NHS are a product of previous failures not only to invest, but to reform. The resources that we are making available will help to lever in long-overdue changes.

The new hospital developments that I have announced will provide new standards of care for patients and a better working environment for staff. There will be workplace nurseries for staff. There will be no mixed-sex wards, but more single rooms. Patients will have access to a bedside telephone and television, and will have the latest scanning and diagnostic equipment. There will be same-day test and diagnosis facilities to make services faster and more convenient for patients.

There will also be more beds in the new hospitals. For four decades, the number of hospital beds has been falling—157,000 were cut between 1980 and 1997 alone. More than 60,000 of those were general and acute beds. In the year to December 2000, the number of general and acute beds in hospitals started to rise again. I am determined that that trend should now continue.

Overall, these new hospital developments will provide almost 3,000 extra beds on the number currently provided. Indeed, in every single one of the new developments more, not fewer, beds are planned. Moreover, I am issuing to the NHS today new guidance, following the national beds inquiry, which requires each region to expand, not to contract, the number of beds available for patients. The prevailing culture in the NHS has been one of bed closures and cutbacks. That is no longer sustainable. What the NHS needs is more, not fewer, beds.

This major programme of investment will bring more staff, more beds and more new hospitals. It will also bring reforms to the way in which health care is delivered. Patients will be treated in modern, high quality facilities with the latest equipment and the best trained staff. Reliability will be improved and waiting times will be cut. Of course it will take time to deliver, but after decades of neglect, the NHS is now set for a decade of sustained growth alongside far-reaching reform.

The choices that we as a Government have made for Britain—economic stability and investment in our key public services—are paying off for the NHS, the staff who work in it and, most important of all, the patients who use it.

Dr. Liam Fox (Woodspring)

I am grateful to the Secretary of State for his statement.

Well, well, well; surprise, surprise. Just before announcing the date of the general election, the Government produce a wish list for voters, bribing them with the taxes that they have not yet paid—good old Labour party pork-barrel politics. I am grateful to the Secretary of State for pointing out that 6,700 extra doctors have joined the NHS since 1997. Given, as he frequently points out, that it takes five years to train a doctor, every one of them, by definition, began his training under the previous, Conservative Government as part of our programme of expansion. We also provided extra nurses, thanks to the increase of more than a third in the number of nurse training places between 1994 and 1997. The Secretary of State conveniently forgot to mention those facts.

The right hon. Gentleman's announcement is a sham. He is going for great headlines. Although he says that he is giving the go-ahead for 29 projects, let us consider the buts, and there are many of them. He is giving the go-ahead for 29 projects, but each will need to be subject to the normal approval process. There are 29, but each will have to confirm viability and affordability and, before it is finally signed off, value for money.

The first of the hospitals will be opened by 2006. The Government have failed to deliver in this Parliament and have already guaranteed that, should they be re-elected, they will fail to deliver in the next Parliament.

I shall ask some questions to ascertain whether the statement is anything more than headline and whether there is anything substantive within it. How, in detail, will the projects be funded through PFI? What will be the length of the average contract through PFI? What is the expected rate of return? How many of the current PFI projects in the national health service are behind schedule?

The Secretary of State talks about seamless local care. I ask him to think again about the way in which he describes seamless local care for patients. He talks about building primary and intermediate facilities alongside new hospitals. Seamless care is a function not of geography, but of co-ordination of services. It is of little comfort to patients who might be at the periphery of a health area if everything is concentrated in the centre. I hope that the right hon. Gentleman will explain what he really means.

I am delighted, at least in principle, by the concept of fast-track units, as the Secretary of State calls them in his announcement. We described them in our "Believing in Britain" document as stand-alone units. The concept has been our policy for some time. I am always ready to welcome the conversion of the Secretary of State to our thinking. In bringing forward the policy, he will have recognised the problems that always exist when attempting to introduce fast-track policies of this nature.

Perhaps the right hon. Gentleman will tell us his estimates for the extra numbers of staff that will be required for the units, and especially his estimates of specialist staff. How will consultant care be divided in the units? Will the same consultants be responsible for all junior staff, even round the clock? These are the practical differences between a headline and a policy.

The Government have missed two factors. First, the Secretary of State says that emergency admissions and displaced planned elective admissions sometimes mean that planned operations are cancelled at the last minute, causing distress for patients and frustration for staff. The greatest problem, in terms of cancellation of operations and frustration for patients and staff, is the Government's waiting list initiative, which throughout the country regularly causes cancellation of operations or worse, forcing surgeons to do things that they do not want to do simply to squeeze more minor complaints through the system to get the waiting list down.

Surgeons at Guy's hospital in London say that they have been asked by management to do fewer hip replacements so that they might deal with more minor complaints in the same amount of time. We think that that is an unethical approach to care and that the Government should abandon that failed policy.

Secondly, the Secretary of State talks about the number of beds, including intermediate care beds. We are seeing a huge reduction in the number of care beds in the community—as many as 50,000 in the current year. That will lead to more bed blocking and less ability to provide intermediate care. It will have a knock-on effect on waiting lists because of cancelled elective surgery.

I ask the Secretary of State to answer eight questions. The number of—[Interruption.] I know that Labour Members think that answering questions in the House is bizarre and unusual, but it is why Ministers come to the House. Will the right hon. Gentleman tell us whether the extra nurses that he talked about will be full-time equivalents? When does he expect to reach the average European levels of expenditure on health to which he alluded? What will the length of the PFI contract be for new projects? What will the rate of return be on these contracts? How many current PFI programmes in the NHS are behind schedule? Can he confirm that the option to return a building to the NHS already exists under PFI and is nothing new? What extra staff will be required for stand-alone units and how will they be recruited? How many care home beds does the Secretary of State estimate will be lost this year, making bed blocking more acute?

We await answers to those detailed questions; that is the difference between a Government who live by headlines and a Government who have thought through their policy. We shall judge the Government not on the promises that they are making today, but on their delivery. They promised to cut waiting lists, yet lists have gone up; cut NHS bureaucracy, yet it has increased; abolish trolley waits, yet they are still there; and get rid of mixed-sex wards, yet they still exist. We judge the Government by what they have done, not by what they promise, and so will the British people

Mr. Dennis Skinner (Bolsover)

Are you going to vote against it?

Dr. Fox

You silly man

Mr. Milburn

If I may interrupt the dialogue, the hon. Member for Woodspring (Dr. Fox) started by praising his party's record. If he wants to quote his party's record, perhaps he will stand by the record that meant that the number of nurse training places were cut under the previous Government, as were the number of GP trainees. They fell by a quarter under the previous Government, whereas they are rising by a quarter under this Government.

I shall deal with the specific issues raised by the hon. Gentleman. The number of extra nurses, doctors and so on that I announced—which, indeed, were announced earlier today—are head court figures, as they were in the NHS plan. The length of the contract for PH deals will vary according to local circumstances. We expect that many contracts will be between 15 and 30 years. As for the cost of the contracts and extra personnel to the revenue budgets of the NHS, we expect that it will amount to an extra £300 million of revenue commitments for the NHS, which it is well capable of affording, given the increases that we have made.

On the number of contracts that are behind schedule, I can confirm that not a single contract is behind schedule. Indeed, many PFI contracts are coming in on time and ahead of schedule. The hon. Gentleman said that the option to return to NHS ownership at the end of a contract is nothing new. Well it was not new under the previous Government because that was not how PFI operated then. We made the change to PFI contracts; in fact, I made it when I was Chief Secretary to the Treasury. That is a new development for PFI.

The hon. Gentleman started with a rather outlandish allegation that the programme was a form of electioneering. It is a strange form of electioneering for a Labour Secretary of Slate to agree to hospitals in the constituency of the hon. Member for Chingford and Woodford Green (Mr. Duncan Smith), the shadow Defence Secretary; in Colchester, which is in the constituency of the hon. Member for North Essex (Mr. Jenkin), the shadow Transport Minister; and in the constituency of the hon. Member for South-West Devon (Mr. Streeter), the shadow International Development Secretary. It is an odd Labour Secretary of State who embarks on electioneering and agrees to new hospitals in the constituency of the hon. Member for Tunbridge Wells (Mr. Norman), the shadow Secretary of State for the Environment, Transport and the Regions, and that of the right hon. Member for Maidstone and The Weald (Miss Widdecombe), the shadow Home Secretary. It is a very odd Labour Health Secretary who agrees to two hospitals in the constituency of the shadow Health Secretary.

The one thing that the hon. Gentleman failed to do in his speech was confirm that he would match our spending on those new hospitals. The truth is that he cannot match it. He cannot match us on doctors, nurses, beds and hospitals because there is a big difference between the parties: the Conservative party is always committed to cuts in public services, whereas the Labour party is committed to investment in public services.

Mr. Bill O'Brien (Normanton)

May I warmly thank my right hon. Friend for his statement this afternoon? On behalf of my constituents in Norm triton and throughout the Wakefield area, may I give a big thanks, because Pinderfields hospital is in my constituency, and that is where the new development will take place?

It has taken four years of Labour Government to provide a new hospital. We appealed for 18 years under the Tories, but got nowhere and today we heard sour grapes from the shadow Health Secretary. We must now get on with the job.

Primary health care provision was allied to my right hon. Friend's statement. Will action be taken to reduce the waiting time to see general practitioners in many of the primary care group areas? Will he assure me that a monitoring system will be established to ensure that PFI delivers the work and goods, as it v, ould be in relation to provision funded by taxation? On behalf of staff and patients at Pinderfields hospital, I express my hope that there will be a speedy start to the development of hospital services.

Mr. Milburn

I am grateful to my hon. Friend for his kind comments. The Wakefield development involves £164 million of investment. As he knows, it is long overdue in the area and will bring benefits to the local health service. However, there will not only be a new hospital at Pinderfields general; I can confirm that the development will also involve additional primary and intermediate care facilities in the north Kirklees area. That is good overall news for the local health service.

Mr. Nick Harvey (North Devon)

I welcome the announcement of the new hospitals and the new emphasis on scanning and diagnostic equipment. However, does the Secretary of State recognise that the real issue is not beds or bricks and mortar, but lack of staff? Is not that at least part of the reason why the first of the hospitals will open in 2006? Has not the use of PFI been the cause of some delay in hospital building, especially in respect of smaller community hospitals in places such as Tiverton and Frome in Somerset? Many of those hospitals feel that development has been delayed specifically because of PFI. Why is there not available in the, public domain more information that compares the value for money of the PFI programme with that of direct financing, and why have some parliamentary questions on the subject taken as long as a year to answer? What level of NHS expertise exists for securing best value for the taxpayer from the PFI programme?

Mr. Milburn

The hon. Gentleman is aware, as we all are, that the trained staff that the NHS needs can be got from somewhere. We are making progress. We have more nurses and doctors and we are getting more radiographers and so on into the system. That is precisely what is needed, but it can be done only through training and recruitment. To achieve that, we must ensure not only the right incentives and pay structures, but the right environment for staff to work in. That is why the new facilities, including new nurseries and so on, will make a genuine difference for staff when they come on line. We shall get there in time. We have today made an important commitment not only to build more new hospitals, but to train more staff for the future. If I could train more staff more quickly, I would gladly do so, but the simple answer is that it takes time.

I think that the hon. Gentleman and his party are wrong about PFI. I know that there are concerns about it in various parties, but we have today shot one of the major foxes—apart from the one on the Opposition Front Bench—in respect of cuts in bed numbers and PFI. People have said in the past that PFI inevitably leads to fewer beds, but I am afraid that the only thing to which it inevitably leads is more hospitals.

Mrs. Llin Golding (Newcastle-under-Lyme)

On behalf of the people of north Staffordshire, I thank my right hon. Friend for this truly wonderful news. Having worked in North Staffordshire hospital, I know how much it will mean not only to patients, but to staff. On behalf of north Staffordshire Members of Parliament, may I ask him to receive a delegation to discuss the extension of the medical facility at Keele university? As a former radiographer, I have another question: will he also discuss with us the re-establishment of a school for radiographers?

Mr. Milburn

I am tempted to say that every silver lining has a cloud, but that would be unkind to my hon. Friend and to the other Labour Members who represent north Staffordshire constituencies. They came to see me some months ago and I know that they have campaigned assiduously for the development and that the local newspaper has also campaigned extremely hard. I am aware of the problems in north Staffordshire, which has two sites with old buildings, dilapidated equipment and an environment that is suitable neither for staff nor for patients. We can begin today to put that right. It will take some time to get there, but we will do so, and my hon. Friend's constituents will have precisely the sort of modern and up-to-date facilities that they have long deserved.

Mr. Michael Fabricant (Lichfield)

Just as I welcomed announcements of new hospital buildings under Conservative Governments, I welcome the same announcements from a Labour Government. I will welcome such developments even more when they are built—if they are built. But what a great shame that I cannot join the hon. Member for Newcastle-under-Lyme (Mrs. Golding) and welcome a new hospital in south Staffordshire. The Minister talked about Leicester and Lewisham, but he did not mention Lichfield. What can he say today to reassure people in my constituency who, for the past three and a half years, have known that our minor injuries unit, renal dialysis unit, day surgery unit and maternity unit are under threat, if not that the Victoria and Hammerwich hospitals are under threat of total closure? Can he give them any reassurance?

Mr. Milburn

I shall gladly look at the situation in the hon. Gentleman's constituency, but if I were him I would be cautious. Before he starts making commitments that his Front-Bench spokesmen clearly are not prepared to make, he and his party must say where on earth they will get the resources from to pay for additional beds or new hospitals. Unless he does that, his points are irrelevant.

Ms Joan Ryan (Enfield, North)

On behalf of my constituents and all the people of Enfield, I should like to say how important and welcome is today's announcement of the success of the bids not just for Chase Farm hospital but also for North Middlesex hospital, which will make a big difference to the delivery of health care in Enfield.

The hon. Member for Woodspring (Dr. Fox) talked about expansion under the previous Government, but my right hon. Friend will know from our meetings that, for many years, Chase Farm hospital was under threat of closure. Because of that threat, it was badly run down and local people lost confidence in it, and, when the Government were elected, staff morale was at the lowest possible point. Labour promised that we would turn all that round and that Chase Farm would have a secure future. I am so pleased that we can say today that we are delivering on that promise, and that Chase Farm has a secure future and will go from strength to strength in serving the people of Enfield. Will my right hon. Friend join me in congratulating the Barnet and Chase Farm Hospitals NHS trust and the North Middlesex Hospital NHS trust, the senior management and all the staff on their work in making the bids robust and successful?

Mr. Milburn

I pay tribute to all involved in putting together the bids, which require a huge amount of effort and work. A great volume of papers has rightly to be prepared. The hon. Member for Woodspring asked earlier about the approvals process, but it would be pretty surprising if we did not have a proper approvals process to demonstrate affordability and value for money—precisely the sort of things that are necessary in the NHS. I also pay tribute to the staff at Chase Farm who have sometimes worked in pretty difficult surroundings. I hope that today's announcement will bring them good heart and good cheer and a bit of optimism for the future.

Several hon. Members


Mr. Speaker

Order. Questions must be brief during statements. The House will realise that there is a time limit on the important debate which follows. I appeal for brief questions so that as many Back Benchers as possible can participate.

Sir Nicholas Lyell (North-East Bedfordshire)

The Secretary of State's announcement will be welcome to many hospitals, but, as the right hon. Gentleman knows, Bedford hospital has been very much at the end of the line for finance since the old days of the resource allocation working party. It desperately needs a new mortuary. Can he hold out any hope from these announcements that it will get one promptly? What can he say on this important subject?

Mr. Milburn

The situation in Bedford will be a matter for local and regional discretion. I think that the right hon. and learned Gentleman is aware that the Government are dramatically increasing capital budgets, first to the regions and then to the individual trusts. More money will go to the trusts than ever before, and they have a discretion to use that as they see fit. It is not for me to second-guess that. If there is a problem in the provision of mortuary pathology services, that should be taken up with the trust management and the regional office management. If the right hon. and learned Gentleman would care to write to me about specific matters, I shall be glad to consider them.

Mr. Alan Meale (Mansfield)

I add my congratulations to the Secretary of State on these magnificent and momentous decisions which are much in line with the approach of previous Labour Governments to the national health service, and contrary to the weasel words of the Opposition, who have tried to turn this into a party political issue connected with the general election. As the Secretary of State said, some of the new hospitals will be in Tory constituencies.

May I say on behalf of the people of central Nottinghamshire, particularly those who work in the health service, that, with the Secretary of State's help, we will make every endeavour to deliver and to continue to improve our health services in the area?

Mr. Milburn

I am grateful to my hon. Friend, who has spoken to me about the problem in the Central Nottinghamshire Healthcare NHS trust, specifically at King's Mill hospital. I pay tribute to the work that he has done on behalf of the local community. Frankly, this investment should have been made in these areas many years ago. Everyone understands that—the opportunity was there. For 18 years, another Government were in power who could have made that capital investment. Sadly, they decided to put other priorities first. Their priority was not investment in the national health service.

Mr. Nicholas Winterton (Macclesfield)

I take the Secretary of State's statement at face value. It indicated a huge additional investment in the health service. I share the gratitude of north Staffordshire for the huge capital project in the area that will benefit many of my constituents. Will he give an assurance that it is not just the number of patients treated in the NHS that matters, but the outcome of those projects. Will he assure me that the position of those with mental illness and chronic illness will not be overlooked under the NHS plan and in the encouraging announcement that he has just made? He knows my interest in the definition of personal social care, and the ability of people with chronic illness to get the medical treatments they need, which sadly they often have to pay for.

Mr. Milburn

The hon. Gentleman is well versed in these issues, and widely respected on both sides of the House for his views on the national health service. He is right that the NHS is having to manage more mental illness and chronic illness than at any time before. I am pleased that there will be facilities for people with chronic illness and mental illness, including a provision in Bristol, in the area of his hon. Friend the Member for Woodspring (Dr. Fox).

Mr. Marsha Singh (Bradford, West)

May I congratulate my right hon. Friend on his statement? I am absolutely thrilled, as the people of Bradford will be, because the hospitals in my constituency serve all of Bradford. I am delighted that, after years of health service cuts, we now have a Government who deliver on their promises. We do not need to electioneer on this subject, because my constituents know that the health service will not be safe under the Tories, whereas it is under Labour. [Interruption.]

Mr. Milburn

Wait until the real electioneering starts!

I am grateful to my hon. Friend. The announcement about Bradford involves a significant investment—more than £100 million. I am well aware that some of the buildings at the Bradford Royal infirmary date from the 1930s, and that at the St. Luke's site they date back even before that to the 19th century. I am well aware of the difficulties that staff and patients have had to put up with for many years. I hope that we can make a start on the project in the Bradford area as soot as possible. It will increase the number of beds, and provide investment in extra rehabilitation services that are sorely needed.

Mr. David Heath (Somerton and Frome)

The majority of the announcements were about large, acute hospitals serving urban populations. What progress is being made on replacing community hospitals, which often face the same problems as old, Victorian buildings in need of refurbishment? They serve smaller towns and rural areas, and include the Victoria hospital, Frome in my constituency.

Mr. Milburn

That is an important issue. The Under-Secretary of State for Health my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), has today announced extra investment o1 £13.6 million in one such community hospital at Sheppey to modernise its facilities. It is important that we apply the same rigour to smaller developments as we apply to big acute schemes. When we came to office, there were many developments in the pipeline that were not getting anywhere. We had to take some difficult decisions about prioritisation. We have done that, and it is now paying dividends. Communities are beginning to get the acute hospitals that they need. I now want to move on to the next phase.

We need to advance the private finance initiative, so that the benefits of private finance go beyond purely the acute sector and into the immediate sector, primary care and the development of community hospitals.

Dr. Doug Naysmith (Bristol, North-West)

I thank my right hon. Friend for his announcement, particularly in the context of its effect on mental health services in the Bristol area. There were many other good things in the announcement, but the five Bristol Members have pressed my right hon. Friend for such a statement for some time.

Does my right hon. Friend agree that the response of the hon. Member for Woodspring (Dr. Fox) was incredibly curmudgeonly, given that his constituents will also benefit?

Mr. Milburn

At best, it was politically inept. I would have expected the hon. Gentleman to welcome two major developments in his area. I find it bizarre that he did not, and I shall be interested to see his press releases later.

My hon. Friend has lobbied and campaigned assiduously for these developments for many years, in the context of both acute and mental health services. They are long overdue, and I hope that they are warmly welcomed in the area.

Mr. Roger Gale (North Thanet)

I am sure that those representing the constituencies in which hospitals have been announced will, when they are built—if they are built—be as pleased as I was when Queen Elizabeth the Queen Mother hospital was built in Margate. Along with many other hospitals, it was built under the last Government. The Secretary of State should bear in mind the fact that building hospitals is not the prerogative of any one Government; it is welcomed on both sides of the House.

The Secretary of State said that modern medicine could not and should not be practised in out-of-date, clapped-out hospitals. Nunnery Fields hospital, in the constituency of my hon. Friend the Member for Canterbury (Mr. Brazier), is one such: it needs to be closed, and indeed it was scheduled for closure.

Because of the closure of so many residential and nursing home beds—the Secretary of State did not comment on that when asked about it by my hon. Friend the Member for Woodspring (Dr. Fox)—we have a desperate shortage of beds, and a problem of bed blocking, in east Kent. The Secretary of State has two letters from me on his desk on the subject, awaiting answer. Will he give an undertaking that Nunnery Fields hospital will not close until a replacement has been provided, and that this glossy programme will include such a replacement?

Mr. Milburn

The hon. Gentleman said that there had been a lot of new hospital development under the last Government. Let me correct him. Between 1980 and 1997, the last Government gave the go-ahead for seven hospital schemes worth over £40 million. During our first three years in office, we gave the go-ahead for 33 schemes worth over £40 million. The hon. Gentleman should put the situation in perspective.

I know that the hon. Gentleman has had to make difficult decisions about his position relating to the reconfiguration in east Kent, and I am well aware of the local controversy surrounding the issue. I hope that today's announcement of an investment of £102 million in new facilities in east Kent will help.

As for bed blocking, the hon. Gentleman knows that we have made resources available to Kent county council, and have also provided resources for intermediate services through the PFI. If the hon. Gentleman is so concerned about social services expenditure in the area, he might have a word with his Front-Bench team, and persuade them to give a commitment to match our additional expenditure on social services.

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

May I echo the comments of my hon. Friend the Member for Newcastle-under-Lyme (Mrs. Golding), and say a big thank you on behalf of everyone in north Staffordshire who has supported the campaign of the local newspaper, The Sentinel, and every member of the North Staffordshire Hospital NHS trust who has worked hard—under the leadership of David Fillingham—to get the bid together and meet the deadlines? May I also thank my right hon. Friend for taking a personal interest in the health needs of north Staffordshire?

Will my right hon. Friend tell us how much money north Staffordshire will receive? May I invite him to visit the area, and to take a close interest in every single development that takes place?

This is wonderful news, and we have real cause for celebration after all those years of no investment.

Mr. Milburn

They do not give up in north Staffordshire!

I will try to pay the area a visit. On the investment, we have put in £224 million. That is a very substantial amount, but the state of the buildings means that it is needed. It will mean that there will be 131 additional beds in the area overall, and I hope that that will be much welcomed too.

Another pleasing element of the north Staffordshire proposals is that the people in the hospital got together with those in the primary care and the community sectors to agree a joint bid. I hope that that will mean that a great many patients may not need to go to hospital at all. That is a good thing: it is a model proposal and it is quite right for us to give it the go-ahead.

Mr. Peter Luff (Mid-Worcestershire)

Does the Secretary of State understand that, although his promise of new facilities at Kidderminster looks like a pretty straightforward bribe to save the Wyre Forest seat at the next election, it should still be good news for many of my constituents in Worcestershire too? However, given the higher mortality rate that always couples out-of-hours surgery and the risks associated with any invasive surgery, is he satisfied that it is safe to provide such a facility many miles from the nearest district general hospital?

Mr. Milburn

I am satisfied about that. The hon. Gentleman alludes to my hon. Friend the Member for Wyre Forest (Mr. Lock), the Parliamentary Secretary, Lord Chancellor's Department. My hon. Friend has worked long and hard to secure that investment for his constituents. He has not been helped by those in the area who have ignored the best clinical advice, which comes from local consultants and GPs. They confirm what we know—that, sadly, it is not clinically safe to continue to provide the existing range of services in Kidderminster. We are doing what must be done, and ploughing in the additional investment for which my hon. Friend has quite rightly campaigned. I am very pleased that we have been able to give that investment the go-ahead, so that the Kidderminster area can have the modern, up-to-date facilities—and the new type of hospital—that it needs.

Dr. Lynne Jones (Birmingham, Selly Oak)

I too welcome today's announcement of significant investment in Birmingham. That investment will go on new facilities at the City Birmingham hospital, and on a new hospital to replace the Selly Oak and Queen Elizabeth hospitals. We have waited a very long time to replace the mixed-sex wards in old Victorian work houses, such as those that I visited at Selly Oak last month. However, my right hon. Friend will be aware that there is considerable anxiety that the taxpayer should not be taken for a ride by private finance companies. Will he assure my constituents that, if public finance proves to offer better value, it will be made available within the same time scale as private finance?

Mr. Milburn

Yes that is always the case. We test developments to determine what will provide the best value for money—providing public-sector cash through the Exchequer, or getting the investment from the private sector. In fact, my hon. Friend will know that the public sector provides the cash anyway. In a sense, it is the same as taking out a mortgage, which is what everyone does to buy a house. It should be no different when it comes to paying for hospitals. At the end of the period—30 years, or whatever it is—if the local health service wants to have the hospital back, that is fine and dandy: the local service will get it back.

When I inspected some of the facilities in Birmingham, I was impressed by the strength of the case mounted by the local health service, and depressed by the state of some of the buildings. They are very old and extremely dilapidated, and this investment is long overdue. I believe that the investment of almost £300 million in new facilities in the Birmingham area will make a substantial difference to health care for patients and to the working environment for staff.

Miss Anne McIntosh (Vale of York)

Today's statement by the Secretary of State is very bold, and welcome for that reason. Will he explain why the proposals do not amount to privatisation? The Labour party was dead against the private finance initiative before the 1997 general election. He will know that the Duchess of Kent's hospital in Catterick—in the constituency of my right hon. Friend the Member for Richmond, Yorks (Mr. Hague)—recently closed. Will he assure the House that, in addition to the expenditure announced in today's statement, extra resources will be given year on year to hospitals such as the Friarage, so that they can take the additional patients that the NHS now has to treat?

Mr. Milburn

With respect, that is precisely what is happening. For the next financial year from April 2001, health authority budgets will be growing by, on average, 8.9 per cent. I cannot remember the figure for North Yorkshire, but it is a substantial amount of money. Frankly, whereas the previous Government failed to put in that investment, this Government are making that investment. The hon. Lady asks what privatisation is. It is forcing people to pay for their hip, knee, hernia and cataract operations: the policy of her hon. Friend the Member for Woodspring (Dr. Fox).

Dr. Phyllis Starkey (Milton Keynes, South-West)

I thank my right hon Friend warmly on behalf of the people of Milton Keynes for his announcement today of a diagnostic and treatment centre at Milton Keynes general hospital. I welcome the recognition of the special problems that Milton Keynes faces because of its fast population growth of 5 per cent. every year. Will my right hon. Friend contrast today's announcement with the historic underfunding of Milton Keynes, as part of Buckinghamshire, under the Conservatives?

Given that there are 16 new centres, will my right hon. Friend give some thought to encouraging networking between them and the existing centre at the Central Middlesex, so that the lessons can be learned about the most effective way to run such centres?

Mr. Milburn

That is an extremely sensible suggestion. We are talking about a new type of development for the NHS, so it would be sensible to learn from experience and from the success at the Central Middlesex. Milton Keynes will receive an additional £9 million of investment in the local community health service. My hon. Friend has raised the rate of population growth with me on a number of occasions, including in our discussions about this new development. I am pleased to tell her that the proposal that we have accepted today will bring about a 16 per cent. increase in the number of operations in the local area.

Mr. Roy Beggs (East Antrim)

May I congratulate the Secretary of State on this unprecedented announcement? I have been here for a long time and there never has been such an announcement before. In congratulating him on the proposed new build, I welcome also the plans to recruit and retain even more nurses, doctors, therapists, scientists and technicians. There Will be some envy in those constituencies that are not currently benefiting from the additional money. Will the Minister of Health in Northern Ireland be kept advised of the excellent progress being made in the NHS here to ensure that we can maintain comparable standards?

May I personally thank the Secretary of State for the decision that has not yet been mentioned—to provide patients with privacy and dignity by getting rid of mixed wards?

Mr. Milburn

I am very grateful to the hon. Gentleman. In this day and age, people should expect that, if they go into hospital, the basics will be right; the food should be good, the care should be provided, the wards should be clean and they should be given privacy and treated with dignity, particularly as so many people who use hospitals are elderly. That is precisely what we must provide and what will be possible in the new hospital developments. Over time, we will make that possible everywhere. The hon. Gentleman knows that we have regular dialogue between the four United Kingdom Health Ministers, and I very much hope that that continues in the future.

Mr. David Hinchliffe (Wakefield)

Substantial numbers of my constituents are treated daily at Pinderfields hospital in temporary huts that were erected for casualties of the second world war. I listened with amazement to the comments of the hon. Member for Woodspring (Dr. Fox) in response to this statement. In 18 years, all we got in Wakefield from the Conservative Government in response to our problems was a private hospital, built at Methley Park, which drew staff out of the NHS to treat people in the private sector. I warmly welcome the Government's announcement today.

In respect of PFI—which may be applied in many of the schemes—there are anxieties among low-paid, non-clinical staff about their treatment. What assurances can my right hon. Friend give to ensure that those people are properly valued within the NHS?

Mr. Milburn

On the last issue, my hon. Friend will be aware that the Government have changed the rules. Under the previous Government, the policy was one of compulsory competitive tendering and compulsory market-testing. Inevitably, that meant that in every one of the PFI deals that went ahead, low-paid staff were automatically transferred out to the private sector. That is no longer the position. It is now a matter of discretion for the local trust to determine whether it wants to retain services such as catering, portering and cleaning in-house, or to transfer staff to the private sector. As my hon. Friend knows, we have taken important steps to protect staff better if they transfer.

I pay tribute to my hon. Friend who has campaigned long and hard for a new hospital in Wakefield. He knows that I am aware of the appalling facilities that staff and patients have had to tolerate at Pinderfields. He knows fine well that the local community, unlike those on the Opposition Front Bench, will welcome today's announcement.

Several hon. Members


Mr. Speaker

Order. Unfortunately we must move on.