§ 7. Mr. David Amess (Southend, West)
What estimate he has made of the cost to the NHS of the increase in national insurance contributions announced in the Budget. 
§ The Secretary of State for Health (Mr. Alan Milburn)
I estimate that the changes to employers' national insurance contributions announced in the Budget will cost the NHS about £200 million in 2003–04.
§ Mr. Amess
I still think that we will have to scrutinise that figure carefully. Will the Secretary of State provide an estimate of the increase in national insurance contributions for senior house officers, ward sisters and consultants as a proportion of their average take-home 16 pay? Will he explain carefully to the House of Commons how the increase will help recruitment and retention in the NHS?
§ Mr. Milburn
I have never yet met a member of staff in the health service who does not believe that the NHS needs more investment; the only people I have met who believe that are Opposition Members. I do not know whether or not the hon. Gentleman is mathematically challenged, but even if the NHS has to make £200 million worth of extra national insurance contributions, it is worth remembering that in the same financial year it will get an extra £5,500 million. Our party supported and voted for that, but the hon. Gentleman's party opposed it.
§ Derek Twigg (Halton)
The message from my constituents is clear: they want a massive injection of extra funding in the health service, particularly in my area, where there are a lot of health inequalities. However, I am sure that my right hon. Friend will agree to look at their concern that the extra money be spent well and efficiently and that the whole service should be better managed, particularly by getting management structures in place. Are the Tories not putting up a smokescreen to try to hide their policy of privatisation, not public funding?
§ Mr. Milburn
I know that my hon. Friend and his constituents, like most people in this country, want to see an expanded national health service. They want more of the national health service, not less. They want more doctors, more nurses, more beds, shorter waiting times, improved diagnostic services and a cut in health inequalities. My hon. Friend is quite right about that. The only way to bring it about is to get some reforms into the NHS and to accompany them with investment.
What my hon. Friend says about the Conservatives is right. Their strategy is based on the four principles of the hon. Member for Woodspring (Dr. Fox). First, they say that the NHS is not working; then they say that it has never worked; thirdly, they say that it can never work—as a prelude to their real agenda, the fourth item, which is to get more and more people to pay for their own care. That is not the right way forward for health care in this country. What people want is a national health service treating people according to need, not ability to pay—a national health service with the right principles and the right level of funding.
§ Bob Spink (Castle Point)
Is the Secretary of State aware that for Littlehaven's—a children's hospice in my constituency—the increase in the wage bill as a result of the national insurance contribution increase in the Budget will be well over £20,000, and that Littlehaven's is funded almost entirely by voluntary contributions, topped up by a tiny amount of grant money through the NHS? Will he increase the money that the hospice receives to compensate it for the increase in national insurance contributions, so that it does not have to sack medical staff?
§ Mr. Milburn
I join the hon. Gentleman in at least one respect—paying tribute to the work of the hospice movement, not just in his constituency, but throughout the country. Hospices do a first-rate job of work. We want to strengthen the partnership between the national health 17 service and the voluntary hospice movement, and we want more NHS money to go into palliative care—not just into hospices, but into palliative care services more generally. That is what we want to see, and what we voted for. It is no use the hon. Gentleman coming to the House and complaining of lack of investment in the NHS or in his local hospices, if he is not prepared to vote for it. On two occasions in the past fortnight he has voted against more money for the NHS. That is what he should go and explain to his constituents.
§ Mr. Nicholas Winterton (Macclesfield)
May I ask the Secretary of State a direct question? I fully appreciate the additional cost to the national health service of the increase in national insurance, but will he give me an assurance this afternoon that that will not prevent the Government, acting on behalf of the national health service, from encouraging the recruitment of additional midwives? I attended the Royal College of Midwives conference in Bournemouth last week, as did the Minister. There is a grave shortage in many parts of the country. If we are to provide maternity services of the quality that I believe we should, midwives are essential. Will the right hon. Gentleman assure me and the House that the increase in national insurance will not prevent the recruitment of additional midwives?
§ Mr. Milburn
No, I do not believe that it will. Already, the number of midwives is increasing, as the hon. Gentleman knows. He is also aware of the substantial commitment that we have given to expanding midwifery services. We expect an extra 2,000 midwives to be working in the NHS by 2004. Of course, that is partly a question of pay and making sure that people who are working very hard in the NHS are properly paid, but it is also a question of making sure that their working conditions and their working environment are right. So yes, I am confident that we will continue to recruit midwives in ever larger numbers in order to give women and families the sort of services that they deserve.