HC Deb 24 June 2004 vol 422 cc1451-69 12.30 pm
The Secretary of State for Health (Dr. John Reid)

With permission, Mr. Speaker, I wish to make a statement about the NHS improvement plan. Almost four years ago, my right hon. Friend the Prime Minister came to this House and made a statement to launch the NHS plan. He said then: The challenge is to make the NHS once again the health care system that the world … envies."—[Official Report, 27 July 2000; Vol. 354, c. 1261.] I can tell the House that we are making good progress towards meeting that challenge. Today, I will set out that progress and our next steps in delivering the world-class service that people in this country deserve and expect.

I can confirm one principle at the outset. We will not waver from the founding principle of the national health service. Under this Government, NHS care will continue to be provided according to need and not according to ability to pay. No one will suffer disadvantage through lack of means, and no one will gain unfair advantage in medical treatment because of their financial position. The comprehensiveness, and above all the fairness, of the national health service are qualities that are already admired throughout the world, with a few possible exceptions, and this Government will retain them.

I can report today that the improvements promised in the NHS plan have been, and are being, delivered. We said that we would put more money into the NHS, in a sustained way—more than ever before. We have done just that, with an average of 7.6 per cent. real-terms growth for the last four years. We said that investment would help us to expand capacity. It has. Compared with 1997, the figures speak for themselves, with 67,500 more nurses and 19,000 more doctors working in the NHS; 68 major new hospitals built, under way or planned; and 224,000 new employees, 84 per cent. of whom are involved in direct patient care.

We said that those increases in capacity would mean improved services for patients and faster access to those services. That is now the case. There are now more than 258,000 fewer people on the in-patient waiting list, compared with March 1997. There are now virtually no waits of more than nine months for a hospital admission—down from more than 18 months in 1997. Almost 19 out of every 20 people are now seen, diagnosed and treated within four hours in accident and emergency departments—some of the best figures in the world. More than 97 per cent. of people can see a GP within 48 hours.

We said that we would put in place reforms to ensure that services improved. We have. We have brought in new contracts, new institutions and new services such as NHS Direct, which was used by 6.5 million people last year, and NHS walk-in centres. We have also embarked on the world's largest health-related IT programme.

Most importantly, we said that outcomes for patients would improve as a result of that investment and those reforms—and they have. To give but two illustrations, cancer death rates are down by more than 10 per cent. since 1997 and premature cardiovascular disease—heart-related—death rates are down by no less than 23 per cent. or above since 1997. So what is clear is that extra investment and capacity have allowed us to meet the people's first requirement: a better resourced, more easily and faster accessed health service in their own area—not perfection, but solid, significant progress. But of course, there is still a huge amount to do, given the position from which we started. I would never claim that everything is perfect, and now is certainly not the time to consolidate or to be complacent; rather, it is the time to renew our radical vision for the national health service of this country—a vision to meet the expectations and ambitions of people today, of this generation, in this country.

That vision embraces an NHS that is not only fair to all of us but also personal—increasingly so—to each of us, offering all our people equal access to, and the power to choose from, the widest possible range of services of the highest quality, based on clinical need and not ability to pay. So today, the NHS improvement plan that I have published and laid before the House sets out radical ambitions: sustaining our record high investment; maintaining our improvement programme; offering patients an even greater degree of power, information, control and choice than ever before; and improving further the health of the population as a whole, targeting inequalities and promoting prevention as well as cure.

Let me give the main features of that plan. The first is investment. As the Chancellor made clear in his 2002 Budget, we are committed to sustained record investment in the NHS. Total investment will rise year on year to more than £90.2 billion by 2007–08, averaging 7.3 per cent. real-terms growth over the five-year period. I can confirm that all of that—every single penny—will be directed towards increasing capacity for everyone in this country. None of it will be diverted as a subsidy for the relatively well-off few to jump the waiting queue.

I can also tell the House today that under that new programme we will limit the whole patient journey from GP referral through out-patients and diagnostic tests and finally to treatment. There will be no more hidden waits—[Interruption.]—the hidden waits that extended to years under the last Government. I can therefore announce that by 2008, building on the improvements we have already made to the NHS, from the time they are referred by a family doctor to the door of the operating theatre, no one in this country will wait more than 18 weeks for an operation, which should ensure an average wait of about nine to 10 weeks for everyone: a maximum wait of years under the last Conservative Government for just part of the patient journey, but a maximum wait of just 18 weeks with a Labour Government for the whole journey—a measure of the difference between the two Governments.

In addition to that improvement in access, we want to fulfil our manifesto commitment and give patients a greater degree of information, power and choice over their treatment—not just for the well-off, not just for those with affluence or influence. We want all patients to be able to choose from a range of services that best meet their needs and preferences. We have been introducing that scope incrementally, as capacity in the NHS increases. By the end of next year, for instance, all patients who need to be admitted to hospitals for elective care will be offered the choice of four to five providers at the time that they are referred for treatment by their GP—[HON. MEMBERS: "Ah!"]. That pledge, which appears to be news to Members on the Opposition Front Bench, was made three years ago. [Laughter.] I am glad that they have now awakened. It is, in itself, a substantial step forward, but they will be delighted to know that I want to go further still today.

I can tell the House today that, by 2008, every patient referred by their GP will be able to choose to be treated at any facility in England—including, of course, their local hospital—that meets NHS standards and can provide care at the NHS price for the procedure that they need. [Interruption.] From a sedentary position, I am being asked—[Interruption]

Madam Deputy Speaker (Sylvia Heal)


Dr. Reid

From a sedentary position, I am being asked what is different from the policy put forward yesterday. I will oblige the House. Let me make it clear that it would be nothing short of hypocrisy to come to the House and promise that greater choice will be open to everyone, while reducing or diverting resources away from the national health service to a privileged few, allowing unlimited waiting times by removing targets and proffering an advantage in access to those with money. That combination would in reality, reduce choice for the many in this country and in practice extend it only to those able to pay the charges outside the NHS in the private sector. That hypocrisy would be precisely the effect of yesterday's proposals from the Conservative party. We will not do that.

Our choice is in reality for everyone, paid for by the NHS and backed by further resources in the NHS, by continuing reform and by new patient rights. But there is another group of patients for whom local services in the community are important—at least to Labour Members—so we will extend the greater personalisation of patient care to people with chronic and long-term medical conditions. [Laughter.] Those people are not a matter for laughter; they are people who are suffering from some incurable and extremely difficult illnesses—arthritis, diabetes and asthma. [Interruption.] They are to be taken seriously, not frivolously.

Some 17.5 million people in this country have long-term conditions that cannot yet be cured and that have a real impact on their life. Providing those people with the personalised support and care that they deserve and need to live fulfilling lives should be a priority for all of us. We will do that by providing thousands of new and additional community matrons, rolling out the expert patients programme across the country and ensuring that the new contract for GPs delivers the best care for patients—thousands of new people in the community to help the 17.5 million people whose suffering was such a cause of frivolity among those on the Opposition Benches.

As the Select Committee on Health has pointed out, we need to ensure that the NHS becomes more than just a sickness service. We have a duty as a Government to ensure that everyone has the chance to live a healthy life, and to foster prevention as well as providing cures. The White Paper that I will publish in the autumn will set out in more detail our plans to tackle the major causes of ill-health, including smoking, obesity and sexually transmitted infections. We will do that by ensuring that the NHS takes a leading role, but that it involves other relevant organisations. [Laughter.] I note that the reference to sexually transmitted infections causes schoolboy humour among those on the Opposition Benches.

The plan that I have outlined today will therefore deliver a national health service characterised by access based on need, not ability to pay; free delivery to everyone, not charges that can only be paid by some; investment in the mainstream national health service, not cuts or diversion; guaranteed waiting times, not unlimited waits; queue cutting, not queue jumping; and a national health service fair for everyone and personal to each of us, not just to those who can afford it. It is above all an improvement plan to ensure that the greatest gift ever from the people of this country to the people of this country—our national health service—will not only retain its basic fairness and equity, but be able to meet the expectations of all our people in this new century irrespective of their wealth, race, geographical dispersion or social standing and background. That is how the national health service started and that is how we will continue in this century. [Interruption.]

Madam Deputy Speaker

Order. The House must come to order.

Mr. Andrew Lansley (South Cambridgeshire) (Con)

I am grateful to the Secretary of State for sending me a copy of his statement, but we knew yesterday morning what he intended. He told the "Today" programme that what the NHS needs is "more targets". No one in the NHS tells me that they need more targets. They tell me that they need less bureaucracy, fewer targets, more autonomy and more resources which reach the front line. Today, we have heard the Secretary of State reiterate Labour's pigheaded belief that setting a target is the same as getting things done. It is not. It is the staff in the NHS who get things done. It is the doctors, the nurses—[Interruption.] Is the Minister arguing with me? It is the doctors, the nurses, the professionals in the NHS, the support staff and the managers—[Interruption.]

Madam Deputy Speaker

Order. This is an important statement; we will have some order.

Mr. Lansley

It is the doctors, nurses and professionals, it is the support staff and, indeed, the managers in the NHS who deliver health care. They tell me that targets distort clinical priorities and that red tape and bureaucracy stop them devoting the time that they wish to devote to caring for patients.

Let us take the Secretary of State's statement on his own terms. The Government have failed through their obsession with plans and targets. Let us look at the NHS plan 2000. It referred to an end to the postcode lottery in the prescribing of cancer drugs", but the availability of some cancer drugs varies from 18 per cent. to 100 per cent. in different parts of the country. The NHS plan 2000 said there would be 7,500 more consultants by 2004", but the latest whole-time equivalent figure is just over 5,000. The director of human resources in the NHS has said: we now know the way the target was originally constructed was not as helpful as it could have been". On mental health, the NHS plan 2000 said that the Government would establish 335 crisis resolution teams, but the chief executive's report says there are 137.

On mixed-sex wards, the NHS plan said: old Nightingale wards will be phased out", but the Commission for Health Improvement found mixed-sex wards and unassigned toilets in one in six of the acute trusts that it reviewed. On cancelled operations, the plan said: From 2000, when a patient's operation is cancelled they will be offered another binding date within 28 days", but last year 5,500 patients were not readmitted within 28 days.

On dentistry, the plan said that the Government were firmly committed"— in this instance Members will note that the NHS plan said "firmly committed"— to making high quality NHS dentistry available to all who want it by September 2001", but 40 per cent. of children and nearly 60 per cent. of adults are not registered with an NHS dentist, and only just over 40 per cent. of dental practices are making NHS dentistry available.

On patient and public involvement, what happened to the letters on an individual's care being copied to the patient? That idea was in the NHS plan, but it disappeared. The NHS plan said that patient and public involvement would somehow be improved. It is my experience in my constituency that a community health council that did an effective job in scrutinising and representing patients is replaced by patients forums, and we do not even know who the members of that forum are. Labour's record is not one of targets set and targets met, but one of targets set and targets not met.

Let us consider what the Secretary of State is saying will happen. There was a lot of advance briefing about public health. We now know that there will be a White Paper in the autumn—as distinct from the summer, when he originally said it would be published. There is an epidemic of sexually transmitted infections. Cases of chlamydia and, I think, gonorrhoea have doubled. HIV infection has increased, whereas after the 1980s a successful Conservative-led campaign was fought against HIV infection and for safe sex.

The Government are now going to have a target on obesity, at a time when it is at a crisis level, as everyone has recognised far too late. As a result of binge drinking, young people are at serious risk of increases in liver disease. TB rates are up significantly and the Government have not delivered an action plan. Some 180,000 people have undiagnosed hepatitis C and there is no active screening programme. The Secretary of State talks about smoking. In his report, Sir Derek Wanless said that the Government's target on smoking was "unambitious". How likely is it to be achieved if the Secretary of State's attitude is that it is one of life's few pleasures? So the Government have failed on public health.

Now the Secretary of State says that the Government are going to think about chronic disease—seven years after they came into office. My hon. Friend the Member for South Suffolk (Mr. Yeo) said in March that it was necessary for us to give patients greater control over the management of their care. Of course the Government are playing a game of grandmother's footsteps: we say one thing, and they follow along. But there is a big difference between the way in which we are going to deliver care for those with long-term diseases and the Government's approach.

We are going to design the service around the needs of patients, and there be an entitlement to a standard of care. The Secretary of State, however, says that he will have community matrons. Community nursing would be a jolly good thing. [Interruption.] The Government Chief Whip might like to know that there are 800 fewer district nurses than there were in 1997. She might also like to know that the number of episodes of care from health visitors has gone from 3.6 million in 1997–98 to 2.9 million and that the number of episodes of care from district nurses has gone from 2.2 million to 1.9 million. It has gone from 370,000 to 320,000 for community mental health nursing; from 930,000 to 830,000 for chiropody; and from 1 million to 500,000 for community dental services. We are not going to take any lessons from the Secretary of State about what is needed in the community—[Interruption.]

Madam Deputy Speaker

Order. Once again, I implore the House to hear these important statements with some civility.

Mr. Lansley

Thank you, Madam Deputy Speaker.

The Secretary of State says that he has now converted to the idea of offering a choice. He might mention that to the rest of his party, because most of them have not. But how lacking in ambition is it for the Government to say that by 2008 people should be able to choose which hospital they have treatment in? It is another illustration of the Government's lack of ambition. We said yesterday—again, if imitation is a form of flattery, I suppose we should feel flattered—that patients should be able to choose where they have their treatment. We want that to be true for elective surgery at the end of 2005. Perhaps there is a practical reason why that will not be possible—for example, the NHS programme for IT not implementing, the electronic booking system in 2005 as the Government said it would. Perhaps the Secretary of State will tell us whether that is the constraint on extending choice in 2005, as we intend to do.

The Secretary of State also says that the Government are going to set a new target for waiting times. What they are proposing that people wait four and a half months for treatment in four years' time. He says that that will be 10 weeks on average. Of course there is a bit of a debate about what the average waiting time is. We are told many times that the average waiting time has gone down, but a letter from the permanent secretary at the Department of Health says: we are admitting a higher proportion of long waiters off the list and the median is rising. So there it is: the median—the average—wait is rising in the NHS, and the permanent secretary to the Secretary of State's own Department tells me that that is true.

The Secretary of State's ambition is in four years' time to make everyone in the NHS wait as long as the average now. We are told that the average wait is about 10 weeks. In fact, it is more like 13. In four years' time, the right hon. Gentleman's ambition is for the average waiting time to be virtually no different from what it is today. What has happened to the Government's ambition? We said yesterday that we want waiting lists to be a thing of the past. Four years ago in the NHS plan, the Government said: Traditional waiting lists for surgery will become a thing of the past. There you have it, Madam Deputy Speaker. That is the difference between us and the Government. They had ambition and they failed; we have ambition and we are going to deliver. The choice for the public is clear: it is between a Conservative party that has the ambition to make waiting lists a thing of the past and a Labour party that wants patients to be left to wait.

Dr. Reid

That seems to have had a salutary effect on the hon. Gentleman's audience. In congratulating him on his appearance on the Front Bench, I must say that he was a bit let down by his colleagues. Only 19 of them were present, and one of them, who has now woken up, fell asleep during his contribution.

Let me try to deal with the hon. Gentleman's comments. I have now discovered why he does not understand the idea of reducing waiting times: he does not even understand the definitions. The truth of the matter is that for 60 years under successive Governments—it did not matter which Government were in power—the definition of a waiting time applied to only one third of the patient journey. It applied only to the period after the diagnosis to the treatment table. That was the only part that was measured. In other words, all the time waiting for a diagnosis and before it—the time between the GP visit and the first consultant visit—was disregarded. It was a hidden wait. So what we have measured for 60 years has been the last third. That last third, which is 10 weeks on average now, was years under the Conservatives.

I am not saying that that one last third will be 10 weeks in four years' time; I am saying that the whole journey—from beginning to end—will be an average of 10 weeks. So the Conservative Government gave us waiting times of years for one third of the journey and we are going to give the people or this country access within weeks for the whole journey. That is the difference between us.

Before I deal with the deficiencies in the NHS that the hon. Gentleman picked out, I will deal with choice. He said that we are promising today what he promised yesterday. That is not true. We are promising to put in the means to get to the end result of giving people real choice. Two things matter for choice. People would prefer to have the best treatment available at the end of the street, in the local hospital, with quick access. The biggest driving force for making people say, "I'd like to go elsewhere", is the lack of capacity in the system and long waits at the local hospital.

Yesterday, the Conservatives promised to give us unlimited waits by removing the targets on waiting times, and reduced resources by taking £1.5 billion out of the NHS for the minority in the private sector. They made a deceitful, hypocritical and disingenuous promise to the British people yesterday, and today we are setting out the means to give people a real choice.

I shall deal with the hon. Gentleman's point about deficiencies in the NHS. Yes, there are grave deficiencies in the NHS. Yes, there are shortages of midwives and of radiologists. Yes, there are still problems of new hospitals needed, new equipment needed and more nurses needed. However, by heaven, after 224,000 more staff—

Mr. George Osborne (Tatton) (Con)

All managers.

Dr. Reid

—40 new hospitals and 2000 refurbished premises—[Interruption.] I am coming to the comment that the additional staff are all managers. Do not worry. On behalf of the staff, I will not miss the Conservative party and hit the wall on that question. If after all those injections of capacity we are still so short, does not that show how dilapidated the NHS was under the Conservative Government?

I shall deal with the figures that the hon. Member for South Cambridgeshire (Mr. Lansley) gave, which in so many areas were spurious. Yesterday, the Leader of the Opposition, from the Opposition Dispatch Box, made the most serious allegation in the most public forum in this country, impugning the staff of the NHS. He at least—now that it has been proven to be wrong—should have returned to the Opposition Dispatch Box and apologised to the House for misleading it. On behalf of his leader, who does not have the guts to do it, the hon. Gentleman should have apologised to the hard-working staff of the NHS. There are the time limits, where 20 months were mistaken for perhaps 14 weeks. That could have happened only to a Tory who was used to 20-month waiting lists for radiotherapy.

After reducing capacity in the NHS and introducing unlimited waits, the Leader of the Opposition then tells us that all waiting lists would be finished by the wave of a magic wand. It is Teletubby time in the House. The right hon. and learned Gentleman really believes that we are in La-La land. Yesterday, he gave us a cobbled together, incompetent, unfair and inefficient replay of the record of the Tory Government, which was a disaster for the NHS, and no one will believe otherwise.

Mr. Paul Burstow (Sutton and Cheam) (LD)

I thank the Secretary of State for the courtesy of allowing me a chance to see his statement and the White Paper before he rose this afternoon.

Does the right hon. Gentleman agree that it is entirely right for Members to bring to the House concerns and complaints from their constituents so as to get justice done, but that it is an entirely different matter to come to the House and parade a constituency case as propaganda? Surely that should not be what we do.

Liberal Democrats have supported the extra investment that is going into the NHS. At the last general election we had the courage and conviction to make the case, and we voted for it in the House. However, that investment will be wasted if innovation is stifled by ministerial meddling. Does the right hon. Gentleman understand that one of the messages that many will take from the statement and the White Paper is that the Government still do not trust the NHS to do the right thing? The culture of targets and tick-boxes, which ties the hands of doctors and nurses, gets in the way of clinical judgment and means that the sickest do not always get treated the quickest.

The Secretary of State has outlined his proposals for an 18-week target from the family doctor to the door of the operating theatre. Will he be honest with patients and start collecting and publishing diagnostic waiting times now? When will he start to publish all the waiting times for cancer treatments?

When it comes to choice, does the right hon. Gentleman agree that access to health care should never be based on a person's wealth, and that subsidising the better-off is no more than a gimmick in search of a blank cheque? On the subject of charges—the right hon. Gentleman has waxed lyrical about the founding principles of the NHS—why has he not taken the opportunity today to end the scandal of elderly people being charged for basic care? If more people are to receive intensive home care, will they have to raid their bank balances to pay for it? Is that what the Prime Minister meant yesterday by the right to charge—a right to charge the sick elderly, the frail elderly—for their basic care?

Why has the Secretary of State failed to announce a long overdue review of prescription charges, something that is particularly relevant to those with chronic and long-term medical conditions? The last such review was in 1968. Surely it is not fair that those who, for example, have diabetes get their prescriptions free of charge—rightly so—while those, for example, with cystic fibrosis do not. Surely that anomaly and that scandal should come to an end.

As for making most use of the investment that is going into the NHS—at a time when seven and a half hospitals, effectively, are being filled every year by those who pick up infections while they are in hospital—why does the White Paper say nothing about improving the way that infections are dealt with in our hospitals?

The future of the NHS, as the Secretary of State has said in his statement, depends crucially not only on services that cure people but on all services that prevent and postpone the progression of ill health. The White Paper sets some targets in that respect, but will the right hon. Gentleman say, for example, on smoking, that it is time to accept the overwhelming public health case and follow Ireland and other countries by banning smoking in enclosed public places?

As for obesity, is it not time to introduce clear front-of-package, traffic-light labelling on foodstuffs to give parents and other customers the information that they need?

The White Paper makes it clear that the Government do not trust the NHS to do the job. Under this Government, choice is for the pushy and the articulate, and under the Tories we know that it is about choice for the wealthy. The NHS must deliver choice for all. That means making sure that we have good quality health care delivered closer to home.

Dr. Reid

I shall respond as briefly as I can. The question of choice goes much wider than hospitals. It is about giving people power. We all know that in the real world there are some people in this country who get choice. There are people outside the NHS who have money. They can get choices that are not available, or have not been until now, to others. Within the NHS there are people who might have connections, influence, a degree of affluence, relations, knowledge and social capital that others do not have, which informally gives them choice.

I exhort the Liberal Democrats not to get into a position where they are against what we are trying to do. They are against much of their own philosophy, in a sense, if they are denying people the empowerment to make choices about their health and health care. We want to extend that to people irrespective of social background. That means collectively putting the finance in to compensate for people's lack of money in their own pocket.

When it comes to decentralisation and targets, I want local decision making. Personalisation is about much more than either the secondary sector or just about the idea of choice. It is about accepting that there are groups in our society—individual, personal-type groups, ethnic minorities, working-class people, and people from the north of England as opposed to the south—who have suffered a widening gap in health outcomes over the past 60 years despite all of the advance. We are committed to tackling those inequalities. That is part of personalisation, as it is about providing care for those who are chronically ill, who know much more about their own illness and disease than they are sometimes given credit for, and information and support in the community to enable them to deal with the situation.

I shall not make any comments about the White Paper on public health because it has yet to come out. I note the hon. Gentleman's comments. At least we are discussing in the most radical fashion the biggest ever programme of potential public health moves. The hon. Gentleman asked me whether I would change the criteria now by which we judge waiting lists. If I changed the criteria mid-term, I would inevitably be accused, even if it were to my own detriment, of fiddling figures. I have said already that we should be completely honest. For the past 60 years, under every Government, there has been a hidden wait, which we should now take into account. Let us do that in the next Parliament. We shall certainly look at diagnosis.

I agree with the hon. Gentleman's criticism of the so-called patients passport. It has been repackaged—the Opposition have shot the messenger and have given the new guy—they are going through new guys at a fair rate now—a little box with a new bow which, however, contains the same product. The patients passport reduces the NHS capacity and opportunities for fast access, forcing people to go to the private sector. The Tories are telling people who can afford half the cost of an operation that they will provide the extra money, but we can read them like a book and oppose their policy completely. Medical need, not the money in someone's pocket, should dictate health care priorities.

Finally, if the hon. Gentleman will allow me, I will avoid the subject of snuffing. I have already been accused of being almost personally responsible for binge drinking and the spread of sexually transmitted infections, so the last thing that I need is to get involved in snuffing with the hon. Gentleman.

Mr. David Hinchliffe (Wakefield) (Lab)

I warmly commend the Secretary of State on his statement and the Government's positive progress in health policy. I have been concerned over the past few years about the increasing consensus between the two major parties on a range of policy issues, including health. I am delighted that at the end of this week there is clear distance between them, on which I commend the Government. I should also like to commend the Opposition, because their policies are extremely helpful to the Labour party.

I should like to ask my right hon. Friend about two things. First, if people are sent to private hospitals to be treated by consultants, whether as private patients, semiprivate patients or NHS patients, they will be seen by people who work in the NHS, as consultants work in both sectors. Is it therefore not nonsense to suggest that by putting people in the private sector we are increasing capacity, as we are simply taking that capacity out of the health service? Secondly, I welcome the fact that in the autumn a public health White Paper will be published. However, will my right hon. Friend reflect on how we can shift the focus of debate on health policy away from an obsession with hospitals and treatment and towards prevention and public health?

Dr. Reid

It is no longer the case that when someone goes into the independent sector they will automatically be seen by someone who also works for the NHS. Some of our actions—incidentally, they brought a new efficiency to private sector services, for which there was previously an unlimited demand because of rising waiting lists—have resulted in the introduction of additional assets in the form of treatment centres staffed by the best clinicians from the United States, South Africa, and Germany. In their own countries, those people provide the best health care only to the rich but they are now here to assist and add capacity to the NHS by providing services that are free at the point of need. That supplements the NHS and is not a substitute for it, and I hope that all Labour Members accept that.

I agree that the old way of doing things, in which we bought individual treatments at any price and were prepared to pay public money to the private sector, no matter what the price, was crazy, inefficient and unfair. That is exactly what the Opposition want to bring back. Just as we are achieving efficiency in the NHS, driven by targets, they are abandoning them, and just as we are introducing efficiency in the private health care sector, because many private providers are performing operations for us at a reduced tariff they want to hand the sector a big book of blank cheques so that anyone who wants to pay half the cost of a private operation will have the rest funded by public money, which is crazy and inefficient. I agree with my hon. Friend about the emphasis on primary care and prevention, and I hope that, despite the headlines that appear on choice, we all recognise that what people in this country want most of all is a decent, easily accessible, high-quality health service in their locality to which they can go in times of need. That is our first priority.

Several hon. Members


Madam Deputy Speaker

Order. Many Members are hoping to catch my eye, so I ask for brief comments, questions and responses, so that more of them are successful.

Mr. John Gummer (Suffolk, Coastal) (Con)

Does the Secretary of State not accept that all waiting times are personal, as they affect individuals? I failed to discover from his statement whether he could meet the considerable concern about the amount of bureaucracy, control from the centre and the fact that people are not free enough, which would allow my constituents to know that they would not have to wait six months to get a hearing aid, would not have to raise private money to provide accommodation for children with diabetes in Ipswich hospital, and would no longer have to wait on trolleys all day in hospital, which is a current issue. Can he explain how he will stop centralisation and enable people to make those decisions locally?

Dr. Reid

If I may say so without ruining the right hon. Gentleman's career, those are sensible points, and I agree with all of them. If people are waiting on trolleys all day that is not acceptable, so I urge him to contact me about that.

We are trying to do two things. First, we are trying to drive the third biggest organisation in the world from the centre with a series of targets that we established some years ago which, as they are met, are not being replaced. Secondly, we are simultaneously changing the system so that patients have more power, choice and information. Gradually, 80 per cent. of the money and 80 per cent. of the driving of the system will be controlled by patients themselves. We are half way through that journey, and it would be crazy to assume that we can drive everything from the centre indefinitely. It would be equally crazy, however, to drop all the targets in our efficiency drive and just put in £90 billion without any objectives whatsoever. No business in the world, whether public or private, would behave in such an irresponsible fashion, and Opposition spokesmen would not have done so if they had not been so keen to cobble a policy together in a fortnight so that they could issue a statement before mine.

Mr. Kevin Hughes (Doncaster, North) (Lab)

I welcome my right hon. Friend's statement, unlike the Opposition spokesmen, who behaved disgracefully while he was making it. As my right hon. Friend knows, most people's contact with the national health service is with their GP, so what does he propose to offer GPs so that they can improve and expand local services at their surgeries?

Dr. Reid

The first, best and most important contact is in primary care, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe), the Chairman of the Select Committee on Health, said. We have already extended choice in that sector, as I can demonstrate. A few years ago, a mother whose child was coughing late at night could not visit a walk-in centre where an appointment is not needed. She could not pick up the phone and ask for advice from NHS Direct, as 6.3 million people did last year. She could not go to accident and emergency and be seen within four hours. All those options are now available, quite apart from someone being able to see their doctor or a nurse practitioner within two days. We are therefore opening up the sector but, in addition, we have a new contract for doctors that encourages them to expand in an entrepreneurial fashion by bringing in chiropodists, nurse practitioners, and physiotherapists at primary care rather than hospital level. We have increased primary care funding for doctors by 33.3 per cent., which represents a genuine advance, and shows that we are taking radical action for everyone's benefit.

Mr. Nick Gibb (Bognor Regis and Littlehampton) (Con)

A constituent of mine told me yesterday about his appalling experiences after he was diagnosed with cancer two years ago at a London hospital. His CAT scans went missing several times, his notes were mixed up with those of another patient, and his consultant's demand that he be treated immediately was ignored by administrative staff. Is that not the result of poor-quality management and administrative incompetence, which are also the principal cause of the spread of MRSA and high levels of waste in the NHS? How will the Secretary of State's announcement today tackle the deep-rooted management problem in the NHS? Will not policies such as foundation hospitals, which increase the diffuse nature of accountability in the NHS, do nothing to bring about high quality modern management methods?

Dr. Reid

The hon. Gentleman will forgive me if, after yesterday, I do not attempt to respond to the accuracy or otherwise of what he claims he was told by someone else who is a constituent. Yesterday should be a lesson to all of us, as the hon. Member for Sutton and Cheam (Mr. Burstow) said, not to use constituency cases, especially when we have not checked the facts against what we are told for propaganda purposes.

If the hon. Gentleman is making a general statement that we want to decentralise more power to patients to drive the system, the answer is yes. If he is suggesting that we need more and better management in the NHS—he is nodding—the answer is yes. That is completely at odds with what those on his Front Bench continually say—that we need less management in the NHS—but at least he is not making the mistake that they make when they continually portray all the new staff in the NHS as useless and unproductive bureaucrats. I can tell the hon. Gentleman that nothing angers the staff more than the constant implication that they are all bureaucrats, and that they are getting lots of money but producing no increased output. It is not true. The NHS staff, including management, but more importantly the 85 per cent. who are involved in direct patient care, do a wonderful job and we ought to be proud of them.

Mr. Jon Owen Jones (Cardiff, Central) (Lab/Co-op)

I congratulate my right hon. Friend on bringing forward the fruits of investment, which the Conservative Opposition have traditionally opposed, and reform, which the Liberal party has traditionally opposed. My right hon. Friend has brought those fruits to us in England, but will he do all he can to encourage a situation that allows his constituents, my constituents and perhaps the family of Madam Deputy Speaker also to benefit?

Dr. Reid

I am always willing to help when asked. Wherever people are—England, Scotland or Wales—there will be a choice at the next general election between two philosophies as regards the national health service. One of them believes in continuing investment for the 95 per cent. of the population who are dependent upon it, continuing reform and efficiency, greater output driven not only by the staff, but by objectives such as any business would have, decreased waiting times, and greater choice in real terms. The philosophy of the other party would offer the old theoretical choice that we all have—of dining at the Ritz, were it not for the fact that we were too skint to do so. The Opposition would divert money away from the NHS to the minority to help the relatively rich jump the queue, they would reduce capacity and, above all, they would introduce the right to charge. That seems to me a pretty clear choice.

Sandra Gidley (Romsey) (LD)

I welcome the Minister's commitment to fairness and equity and the NHS being free at the point of delivery, but that is all very well unless one happens to be old. He said little about choice in long-term care, and little about the fact that people have to supplement that care from their own pockets. What do the old look forward to? Would it be better to provide free personal care for the elderly?

Dr. Reid

It is a little unfair to say that I said nothing about the elderly or chronic care. I did speak about chronic care. On personal care, let us be quite straight. We have made a decision in this country that there will be free medical care for everyone, and that in the vast majority of cases there will also be free personal care. About 30 per cent. of people who are the better-off have to contribute towards their own personal care, not medical care. If we were to say that everyone including the best-off in Britain—including millionaires—would also get free personal care, it would cost us £1.7 billion, which we would have to take from elsewhere. We have made a decision, consistent with our priorities, that it is better to allocate that to those who cannot afford the medical and the personal care. That is a judgment that we have made.

Finally, I did not comment when the hon. Member for Sutton and Cheam mentioned it because it seems a bit churlish, but it would be a little more consistent if what was suggested by the hon. Lady was not entirely contradicted by Liberal councils, including, say, Cumbria, which is introducing charges for social care for the elderly in the area that it controls.

Mr. Dennis Skinner (Bolsover) (Lab)

Is the Secretary of State aware that the most important decision taken by the Government in the past two or three years was the brave decision to increase national insurance by 1 per cent. in order to ensure that we had the wherewithal to make the massive improvements that we have made in health and to make even greater improvements in the future? May I also inform him that I am pleased that there is a manager in the national health service—the Opposition call it red tape—who sends me a letter to go for a cancer check-up every six months? I am pleased that he is a manager looking after me. As for being a target, yes, I am pleased to be a target when I go for another treadmill test in order to look after my heart. In an era when technology is so important in the health service, we do not see all the people who are helping us dressed in white uniforms. In all the policies that we present, we have to please people and persuade them, but with the national health service, we must please, persuade and inspire. That is what we are doing today.

Dr. Reid

That is certainly what my hon. Friend did, as he always does, to me. If we were looking for the living embodiment of the huge benefits that the NHS brings to the country, we could not find a national treasure comparable with my hon. Friend. He is right about inspiration. Let us remember when this country decided that everyone, irrespective of their background or their money, would be an equal partner in the fight against that great disease. It was after everyone in this country, irrespective of their background, had fought against the great evil of fascism on the continent, when the country was on the verge of bankruptcy and after it had come through six long years of war. If we could afford a system that gave everyone in the country health care irrespective of the money in their pocket at a time of such difficult circumstances, surely to God everyone in the country apart from those on the Opposition Front Bench believes that we can provide it in this century as well.

Mrs. Cheryl Gillan (Chesham and Amersham) (Con)

My constituents in Chesham and Amersham will not be impressed by the self-congratulatory statistics trumpeted by the Secretary of State, not least because they get 18 per cent. less per head than the average funding in the national health service. I hope the right hon. Gentleman will be grateful to me, as I shall give him an opportunity today to put his money where his mouth is. He will be familiar with the National Society for Epilepsy in my constituency, which looks after people in the NHS from across the country who have a chronic and long-term medical condition—epilepsy. The NSE does not have the money to modernise its care homes. If the Secretary of State really means that he will provide those people with the personalised support and care that they need and deserve in order for them to live fulfilling lives, and that he will make that a priority, as he said in his statement, will he now agree to fully fund the Government-required upgrades at the entire site of the National Society for Epilepsy? When can I tell the chief executive that he can expect the cheque for £17 million?

Dr. Reid

First, whatever the hon. Lady thought about the deficiencies of what I said. I hope that at least she welcomes the fact that I prioritised chronic care in terms of people and resources and gave it the attention that it should receive. I do not blame her at all for raising one specific charitable cause and asking me to agree immediately to pay that £17 million. I know she will understand if I do not give her an instant decision on that. I look forward to even closer work between the state sector and the charitable sector. I know that the National Society for Epilepsy and others do a huge amount of good. I do not know the details of the case, but I hope she will write to me about it. I will demur from making a rash decision. We have had enough cobbled-together decisions from the Opposition Front Bench in the past few days without my making a sudden one before giving the matter the fullest consideration.

Tony Wright (Cannock Chase) (Lab)

The health service is now improving dramatically, and if we can avoid the idiocies of the Conservative party, it will continue to do so. I was interested in what my right hon. Friend said about giving guarantees to patients on waiting times. Can he tell us exactly what he means by guarantees in that context and what will happen if the guarantees are not met?

Dr. Reid

What I mean is that we already have plans, from December next year, at the point of referral, which is when a patient goes to the doctor, to put in the technology, establish the rights and customs and put in the resources to ensure that people are not simply told, "You will go to your local hospital, but go home; it will write to you in due course, perhaps in a week or a month, to tell you when you will go." We have already established a system in which people will be given not only a degree of choice—a choice between four other hospitals or treatment centres apart from their own—but an ability to book online at their convenience a time and date that is most convenient to them. We are going to retain that arrangement, but in addition, by 2008—we will be able to have the IT in place by that time—people will be able to get rough information about other hospitals and treatment centres throughout the country to enable them to say that they want to go somewhere else in England.

I should point out that, as we reduce the waiting times and increase the capacity, the normal expectation would be that fewer and fewer people would want to exercise that choice, but they will have the right to do so. If they discover that the area that they choose cannot meet the 18-week time limit, they will have the right to say that they want to be treated somewhere else or to go ahead and say that they choose to wait longer to get their treatment. If an offer from the primary care trust is not met within 18 weeks, that will be reflected in the assessments that are made by the health care commission, which eventually feed through to the allocation of resources.

Sir Nicholas Winterton (Macclesfield) (Con)

I am sure that the Secretary of State will agree that hon. Members in all parts of the House have shown total commitment to the health service. With that in mind, I wish to follow up the point raised by the hon. Member for Romsey (Sandra Gidley) in respect of chronic and long-term medical conditions. Will the Secretary of State give the House a commitment that the Government will look at funding long-term chronic conditions and that they will not expect people to pay either in full or in part when they have diseases such as Alzheimer's, and also not expect them to he charged by social services when they need to go into a nursing home for ongoing care and treatment? That is critical. The situation has been neglected by successive Governments, and I believe that it is an injustice that needs to be rectified.

Dr. Reid

First, I understand that some people in all parts of the House are committed to the national health service. I do not question that, although it applies to some people, not all. Secondly, I understand the point that the hon. Gentleman makes and the passion and sincerity with which he makes it. It is a difficult choice. Of course, I would not want it to be thought that we do nothing for the chronically ill, and I have made further announcements today in that regard. We help with social work costs, and the idea of the community matrons—I mentioned that there will be 3,000 additional ones—is to help people to stay at home rather than go into homes. We pay all the medical care and, for about 70 per cent. of people—I speak from memory—all the personal care. We try to make that distinction at the same time as using the money efficiently in allocating the £1.7 billion that would otherwise be spent in giving everyone free personal care. We think that we are making the right decision. I do not pretend that it is an easy judgment. Of course, we keep it under review every time we look at expenditure, but I cannot tell him today that we are going to change the position.

Ms Dari Taylor (Stockton, South) (Lab)

I warmly welcome my right hon. Friend's statement, which I believe was powerful and persuasive. In particular, I see community matrons as an excellent innovation, but I am seeking reassurance. Labour's 2001 manifesto stated: We will give more patients choice. I have no problem with that, but I am seeking reassurance that the choice that we are making available to patients will be free at the point of use. I am most particularly seeking reassurance that, when that choice is given, we will be giving it because we have high-quality services.

Dr. Reid

I can absolutely give my hon. Friend that assurance. Those of us on the Labour Benches have known too well over the decades how the incantation of "We are all free to choose to buy a Rolls-Royce" and the theoretical freedoms that are always espoused on the Conservative Benches mean nothing if we do not have the means to exercise that choice. Indeed, the whole mission of the party in which I was brought up was converting that theoretical choice for the many into real choice by giving decent wages and public provision. That will be the case. We will not introduce charges, unlike the Opposition. What we will do is take the public services, which are already fair, and make them more personal by building them around the convenience of today's individuals.

Rev. Martin Smyth (Belfast, South) (UUP)

The Secretary of State has referred time and again to the national health service and to England, Scotland and Wales. Has he consulted his colleague who deals with the health service in Northern Ireland, bearing in mind that some of the specialist units have to be located in England or elsewhere other than Northern Ireland because its population is too small?

May I also press the Secretary of State on provision for general practitioners? I am aware that some GPs in Northern Ireland have been told that they cannot even get a guarantee that they will move into new premises in 2005. I will take up the matter with the appropriate Minister, but it is important that, when we are talking about a national health service, it is just that, and not simply an English national health service.

Dr. Reid

The hon. Gentleman will allow me to explain that the only reason why I did not mention Northern Ireland and referred to Scotland, Wales and England was that I was speaking in the context of a choice between the Conservative and the Labour parties. He would not want me to misportray the important role that he and his party play in Northern Ireland. Of course, the facilities that are used here and extended to the people of Northern Ireland will continue. We keep in close touch with the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for Basildon (Angela Smith). The last point is a matter for her, but I will see that we bring to her attention the fact that the hon. Gentleman has raised it today.

Jon Trickett (Hemsworth) (Lab)

On the subject of choice, is it not clear that there are now two visions for the national health service in this country? When people reflect on those two visions, the choice of the nation will be the vision espoused in my right hon. Friend's excellent statement.

In an organisation as large as the NHS, the devil is often in the detail. Will my right hon. Friend or one of his colleagues please meet me and one or two hon. Friends to discuss the situation in Pontefract hospital, where an inherited cumulative deficit appears to be inhibiting the further development of the NHS? In particular, will he ask one of his officials to look at the case of Mr. Jason Day in Featherstone, a constituent of mine who was diagnosed as suffering from multiple sclerosis? The money is available for beta interferon to be prescribed to him, but there appears to be a financial problem with the clinic allowing the diagnosis to take place. I would be grateful if he could look into those matters.

Dr. Reid

I can give my hon. Friend that assurance. Indeed, I think that the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), has begun to look at some of those matters, and he will be happy to continue his discussions with my hon. Friend.

Mr. George Osborne (Tatton) (Con)

Despite the best efforts of the East Cheshire NHS trust, which serves my constituency and that of my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton), some of my elderly constituents face very long waits for the fitting of digital hearing aids. Will the Secretary of State allow those constituents to go to other hospitals in the region that might be able to fit such hearing aids sooner and greatly improve their quality of life?

Dr. Reid

We have made progress, but I note what the hon. Gentleman says. We are investing more money on this matter. While such hearing aids were technologically available under the previous Government, they were not available in practice because the money was not there to get them. Any delay for someone in such a distressing position is a bad thing, and we will try to look at what we can do to speed up the process. What he cannot do, however, is one day demand more efficient production of more equipment by more people in the NHS, and then tell us the next day that the Conservatives are going to take out £1.5 billion to help the relatively well-off to jump the queue.

Laura Moffatt (Crawley) (Lab)

At a recent consultation with the families and friends of chaotic drug users, the top recommendation on the treatment and care of such drug users was more targets. Not only those who work in the service, but those who use the service recognise that targets are an important driver in improving services. Does my right hon. Friend agree that those who advocate an alternative to targets are making a huge mistake?

Dr. Reid

Absolutely. No one was surprised when the Conservative party introduced incompetent and unjust proposals, and no one expected those proposals to be competent and fair. Those of us who remember the claims that the Conservative party used to make thought that its plan might encourage efficiency, but when it abandoned the drive for efficiency and reform through targets to match the big investment in the public sector, and announced that it would subsidise with public money anybody to pay any price whatsoever in the private sector, without regard to limitation or efficiency, it abandoned any pretence of being a serious contender to form the Government of this country.

Sue Doughty (Guildford) (LD)

We have heard little about psychiatric care, other than the important topic of Alzheimer's. Good psychiatric care can transform an individual's life, but excessive delays and a lack of resources can be disastrous for individuals and for those around them. Far too many problems occur in my constituency because of delays and a lack of resources. What hope can the Secretary of State give to me and to my constituents in Guildford that improvements will be made?

Dr. Reid

For a start, we are putting in more resources and more money, but I will not pretend that instant solutions are available in psychiatric care, dentistry and one or two other areas. Last night, I was amazed when the Leader of the Opposition revealed to the assembled world that, if he waves his magic wand, waiting lists will somehow disappear, meaning that nobody would ever have to wait for anything. Indeed, under the Leader of the Opposition, people would be operated on before they were ill in order to avoid any Form of waiting list. I cannot make such promises, but I can promise greater resources and more personnel. It is difficult to recruit psychiatrists and psychologists, but we are minded to do so and mental health care is a priority.

Mr. Speaker


Mr. Gordon Prentice (Pendle) (Lab)


Mr. Speaker

Order. The Select Committee stated one hour; I have allowed an hour and 10 minutes. Perhaps the hon. Gentleman should examine the Select Committee's recommendations before he mutters and complains.