NHS Modernisation

HL Deb 15 March 1999 vol 598 cc534-48

6.57 p. m.

Baroness Hayman

My Lords, with the leave of the House, I should like to repeat a Statement made in another place by my right honourable friend the Secretary of State for Health. The Statement reads as follows:

"Madam Speaker, much of the National Health Service which we inherited from the previous government was run down and shabby. Much of its investment in information technology had been an expensive failure. Much of its equipment was unreliable and let down both patients and staff. Patients waiting on trolleys had become a commonplace feature of the service. That is why one of the top priorities of the new Government is to modernise the NHS, build new hospitals, replace outdated and unreliable equipment and give patients quicker, easier and more modern access to NHS services.

"We are already committed to investing an extra £21 billion in the NHS over the next three years. The biggest hospital building programme in the history of the NHS is already under way. This coming year at least £350 million will be invested in upgrading and replacing outdated equipment.

"Today I can give the House details of an additional £200 million to be invested in the coming year to speed up our programme to modernise the NHS. This is made up of £100 million to be invested in modernising accident and emergency departments and, drawing on the example of NHS Direct, in improving rapid access to professional advice and help for patients. The second £100 million will come from the National Lottery and will be used to step up the fight against cancer by helping provide new and replacement equipment like linear accelerators, diagnostic machines and scanners as well as extending the services provided by hospices. What better use could there be for lottery money.

"Earlier this year I was able to announce that £30 million was to be invested to improve 79 accident and emergency departments round the country. That will be funded from the NHS Modernisation Fund. Last Tuesday in his Budget the Chancellor of the Exchequer announced that £430 million from the Government's Capital Modernisation Fund had been earmarked for investment in the NHS, and that £100 million would be made available this coming year to modernise the NHS. Between £70 million and £80 million of this will be invested to modernise all those A&E departments that remain in need of improvement. These improvements will include special areas for children and easier access to X-ray, pathology and pharmacy services. The layout and furnishings of A&E departments will be improved to make them both more pleasant and more secure. Video surveillance and alarm systems will bring greater efficiency and add to the security of both patients and staff. Some modernised A&E departments may incorporate an NHS Direct telephone point. All A&E departments which need it will benefit from some or all of these changes.

"A survey by the Royal College of Physicians published early in 1997 showed that fewer than half the hospitals with A&E departments had an admissions ward. Since that survey the numbers without either an admissions or observation unit have been reduced to 22 out of 202, and by the end of this initiative only five will not have one and all five have good local reasons for not doing so.

"Proposals which are likely to be funded under the new A&E initiative include extension of children's A&E at the Royal Liverpool Infirmary, improvements at Sheffield Children's Hospital and in children's facilities at North Staffordshire Royal Infirmary. In Ipswich there is a major scheme including improvements to resuscitation facilities and a children's area, and in Luton more resuscitation facilities and close circuit TV. Some £250, 000 worth of improvements are intended at the Royal London in the East End and a similar sum at the Mayday Hospital, Croydon. Large-scale improvements are intended at Southampton General and a new observation unit and better facilities for the GP co-operatives are planned for Frenchay Hospital, Bristol. These are just a few examples of what is planned for hospitals in every part of the country.

"This is the biggest programme of investment in A&E services in the history of the NHS. It will cover every part of the country. By April 2000 every A&E department will have been modernised or work will be well on the way. It should ensure that patients are treated more quickly, more effectively and with greater privacy than ever before. I am determined to make sure that both patients and staff get maximum benefit from the A&E modernisation programme, so it is not just a matter of new buildings, new plant and new equipment. We have to make sure that the new and better ways of organising A&E such as emergency nurse practitioners and greater use of telemedicine are taken up all over the country. We need to speed up the spread of best practice. I am setting up a team of professionals to spearhead this work. I can announce today that the team will be led by Mike Lambert, A&E consultant at Norfolk and Norwich Hospital.

"This A&E modernisation programme will not just be good for patients and staff. It will be good for jobs, not just for the builders who do the work on site but also for firms who supply building materials and specialist fittings. Let me give just one example. The A&E department at Portsmouth has just been refurbished at a cost of just over £1 million. It used materials supplied by more than 20 firms from all over the country. Orders, large and small, included locks from Walsall, paint from Darwen, weather proofing from Slough, carpet from Swindon, wash-basins from Rugeley, partition walls from Loughborough, wall units from Broadstairs and the specialist security reception desk came from Glasgow. The A&E modernisation programme will reflect such orders one-hundred-fold.

"The remainder of the £100 million from the Government's Capital Modernisation Fund will be invested in improving direct access to the NHS. The success of NHS Direct, the nurse-led 24-hour helpline, has demonstrated the public demand for rapid direct access to professional advice and help from the NHS. Following the success of the pilot schemes, NHS Direct has already been extended since Christmas to cover 5 million extra people in the Black Country, Essex, Northampton and West London and will cover 20 million by Easter. Its success has also shown that, given the chance, the talented staff of the NHS can do a brilliant job supplying what the public want. We are now considering an NHS online service to provide a web site with on-line access to a wide range of health information. Between £20 million and £30 million is being made available in the coming year to finance capital investment in further developments in direct access to the NHS, including pilot schemes for walk-in services. These could include services provided by GPs or practice nurses located in or near accident and emergency departments; out of hours services provided by GP co-ops; and services in main streets or shopping malls.

"We want, as with NHS Direct, to work with the professionals to try out direct access, walk-in services in places and at times which are particularly convenient to patients. Some schemes may be confined to providing advice or directing patients to existing services for treatment or care. Others, particularly those associated with A&E departments may provide treatment and care, there and then. This is not intended to replace general practice but to augment it. All these ideas go with the grain both of modern living and what the health professionals are already developing. The new Government are determined to give impetus to all this to help create a new NHS for the new century.

"That brings me to the extra £100 million which will start to be invested in the coming year to augment the existing NHS investment in the fight against cancer. In line with our election promise we have set up the New Opportunities Fund to make sure that more money from the National Lottery goes into the things the people of this country want to see it spent on. Every time there is a discussion about what to do with lottery money, thoughtful people ask why some of it is not being used to combat cancer. Well from now on, it will be.

"Over the coming three years £150 million from the New Opportunities Fund will be invested in tackling cancer in the UK as a whole. In England we want to make a major start this year in investing in new equipment. The order making this possible was laid by my right honourable friend the Secretary of State for Culture, Media and Sport. The direction he issued at the same time makes clear that the focus of this initiative in England will be to augment voluntary efforts to raise funds to provide new and better equipment, including breast screening units, scanners and linear accelerators and also to help hospices and palliative care. The aim is to provide additional equipment and replace unreliable equipment. It is likely to help fund, for example, replacement linear accelerators at the Christie Hospital in Manchester or new equipment for the diagnosis and treatment of cancer of the colon at Lewisham Hospital which my right honourable friend and I visited this morning.

"All this money comes on top of the extra funds previously announced for the NHS and will help the NHS in every part of the country to catch up with more modern standards of cancer diagnosis and treatment. The initiative has the strong support of Macmillan Cancer Relief, Marie Curie Cancer Care and the National Council for Hospice and Specialist Palliative Care services. It comes on top of the extra £30 million we have invested in breast and colorectal cancer over the past 18 months and the further £40 million we are making available in the coming year to combat breast cancer, colorectal cancer and lung cancer and our commitment to speeding up specialist attention for people suspected of suffering from cancer.

"The commitments I have announced today will speed up the renewal and modernisation of the NHS. They will make services more readily available and more dependable. At the same time they will make it easier for the dedicated staff of the NHS to provide quicker and more high quality services. That is only possible because we have a Government who invest public money wisely and have the right priorities".

My Lords, that concludes the Statement.

7.7 p. m.

Earl Howe

My Lords, once again the House has cause to be particularly grateful to the Minister for repeating the Statement on the Budget settlement for health. My only slight regret, if I may be candid, is that there is a rather unnecessary tone in the opening sentence which seems to cast aspersions on the record of the previous government. I am sorry about that.

At first blush this is all good news for the health service, which we welcome. There is no doubt that many accident and emergency departments in acute hospitals need additional funding to help them to improve services to patients. It is true to say that improvements of this kind will also help doctors and nurses, who can suffer considerable levels of stress in trying to cope with working in conditions that are far from satisfactory. As we have said before from these Benches, it is a remarkable tribute to doctors and nurses that the pressures experienced during the past winter in A&E departments did not lead to greater difficulties than they did.

One of the lessons learnt from last winter was that money and schemes designed to alleviate A&E pressures should be announced in good time so that hospitals can plan ahead properly. It has to be said that the Government's announcement last winter was far too last minute for many hospitals to take timely action before the pressures built up. Can the Minister say whether the amount of money allocated for this up-grading work to A&E departments is based on any preliminary assessment of need? In other words, how many hospitals are likely to benefit from this funding? How will bids from hospitals be assessed and ranked?

I am confused about whether this money is really new money. There are two aspects to that. It is said to be part of the capital modernisation fund, so I am not sure whether this is money that has been announced before in one form or another. Secondly, on 9th November last year the Secretary of State announced £250 million of additional spending following the pre-Budget announcement. The NHS confederation spokesman, Stephen Thornton, said at the time: This is really only next year's money paid early". Was he right to say that and, if so, is any of the money that we are talking about today part of that previously announced package?

The other area of puzzlement relates to the capital modernisation fund. It is very difficult for those outside the DoH to keep track of the portion of the fund that has now been earmarked for various purposes. The modernisation of A&E units seems a perfectly bona fide use for modernisation fund money, unlike the funding of the nurses' pay award from the NHS modernisation fund which came as a somewhat unexpected use for it. To my mind, at least, pay should fall into the category of regular expenditure. Can the Minister say how the modernisation fund is now placed after these latest calls upon it?

I do not know whether the Minister recalls, but her party pledged in 1996 to set up a taskforce to monitor the number of patients forced to wait on trolleys for treatment. I am not sure what has happened to that idea. It does not seem to have been proceeded with. The worry I have is that if one dedicates wards for people waiting for A&E then one is bound to reduce capacity elsewhere in hospitals. I would welcome the Minister's comments on that.

Turning to NHS Direct, once again I have a sense of déjà vu over what has been announced. Have the Government come to any conclusions as to how NHS Direct will be organised on a national basis? National centres are likely to be more efficient and lead to more uniform standards but, at the same time, they are more likely to reduce co-ordination with local GPs; whereas local centres based in practices may have advantages; they may also lead to a lack of uniformity in standards.

It would be impossible not to welcome a new investment of £150 million into cancer care. In particular, it was heartening to hear mention in the Statement of the Christie Hospital in Manchester, which the late Lord Dean of Beswick did so much to support. I am always worried by the appearance of Lottery money in this context. Can the Minister reassure me that none of the proposed expenditure represents what is normally regarded as core NHS spending? It would be quite wrong to use Lottery money to take the place of central funding.

I shall conclude by making one or two comments about the context in which the Statement has been announced to Parliament. The 6 a. m. news on Radio 5 Live contained a detailed report on the setting up of admissions wards within hospitals which could only have come from a detailed knowledge of the contents of the Statement. It has also appeared on BBC Teletext. The Statement on the nurses' pay award was leaked to the press more than two weeks before publication; the Statement on Ashworth Hospital was leaked to the Daily Telegraph one day before the delivery to the House; the Statement on mental health was leaked to the Sunday Telegraph two days before publication; the Statement on social services appeared in the Independent and the Guardian on the morning of publication; the Statement on safeguarding children appeared in the Evening Standard on the morning of publication; and the Statement on health spending of March 1998 appeared in The Times on the morning of delivery to the House. I do not believe that I am alone in finding that unacceptable. I hope that the Minister can provide some reassurance that she and her right honourable friends will do all that they can to stop that kind of practice.

7.15 p. m.

Lord Clement-Jones

My Lords, I join the noble Earl in thanking the Minister for repeating the Statement made in another place. I have very similar concerns about understanding the exact amount of money involved in the Statement. It is difficult enough as it is to distinguish between the capital modernisation fund and the NHS modernisation fund and to understand the linkages between the two when, for instance, the £30 million previously announced for accident and emergency comes out of one fund and the current expenditure today, it appears, comes out of another.

In addition, of course, as I understand it, this money is brought forward money rather than new money, as was announced on Budget Day. The Chancellor was basically saying that £250 million could be brought forward from later years into this year, and in that regard the NHS, I assume, is getting something approaching £70 million or so additional funds. Sometimes it is rather difficult to track and it would therefore be helpful if in future Statements the Government were able to be more precise about what money is involved in terms of being brought forward, how much money is new and how much has already been announced in any Statement. Otherwise, bald figures such as these are extremely difficult to track.

As I understand it, we have the announcement today of expenditure of £100 million which comes from the capital modernisation fund but we do not yet have an understanding of how much will come out of that fund and how the remainder of the £430 million will be spent over the next two to three years. Again it would be helpful in terms of planning by NHS trusts if that information were available.

That said, however, I very much welcome the additional expenditure announced by the Government for accident and emergency. That is a proper response to the winter pressures and the problems in the NHS that we have seen over the past few months. Patients waiting on trolleys is completely unacceptable. The idea of admissions wards is a good one and is clearly an imaginative way of dealing with some of the issues.

However, at the end of the day, capital expenditure must be linked with the staff to go with it. Without the commitment on staffing the capital improvements that are taking place in accident and emergency will not tackle the winter pressures that have been identified. Furthermore, in the context of accident and emergency, it is worth while taking a look back at the Audit Commission report of 1996 which discussed the issue in considerable detail. It is not enough simply to look either at staffing or at capital expenditure. For instance, are the Government looking at other areas such as taking steps to meet the resource requirements of supporting an effective emergency service, in particular specialist staff and in-patient beds? Other recommendations include setting a research agenda to build a robust knowledge base for decisions about the future of emergency care; optimum approaches for meeting a full range of emergency needs; how patients' views can be ascertained in a way which is useful to improve care; the cost and quality of alternative forms of emergency services; improving education to facilitate informed self-care and first aid as well as more appropriate use of alternative facilities for emergency care; and, finally, and very importantly in the context of a great deal of the load that was put upon accident and emergency departments by the flu epidemic—or perhaps I should say the flu non-epidemic—communicating to the public the need for change in the organisation and use of accident and emergency departments so that it is clearly seen to be inappropriate to refer yourself to accident and emergency in those circumstances. It would be helpful to have the Minister's response on those aspects.

I also welcome the proposals for better access to primary care. But I am somewhat confused. The noble Earl referred to expenditure on NHS Direct, but I think that this is analogous to NHS Direct. This does not represent further funds for NHS Direct. We have asked many questions in the past about that particular aspect— I am sure we will ask more in the future—but, as I understand it, this is building on the experience of NHS Direct to improve primary care and other aspects of the NHS.

We on these Benches welcome the additional expenditure on cancer equipment and treatment. However, £100 million of lottery funding has been spent on cancer treatment. The Government admitted in their manifesto that this was a core area for additional expenditure. It seems extraordinary that a transfer of responsibility from government to lottery funding is taking place. We have grave doubts about that. If this area is a major priority for the NHS, should it not be funded out of ordinary mainstream NHS income? Where do we draw the line? What other core NHS expenditure will be borne out of lottery funding? Where does it end?

We are talking about capital expenditure and about an important set of components. We welcome the fact that there are funds which allow capital expenditure to be made. That said, there are other aspects of capital expenditure within the NHS which give considerable cause for concern. I have previously raised the issue of how PFI funding is proceeding. The evidence so far is that that is providing very poor value for public money. I believe that the Government have now succeeded in uniting the BMA, the NHS Confederation, UNISON and the Health Select Committee in being extremely critical of the current PFI programme. If the Minister is able to respond to that point, we on these Benches shall be grateful.

Baroness Hayman

My Lords, on the noble Lord's last point, we shall have an opportunity to discuss these issues later this week in relation to a Question that he has tabled. Therefore, perhaps I need not go into the issues surrounding the PFI in response to comments made from both Front Benches.

The noble Earl began his remarks with a caveat, so perhaps I, too, may begin with a caveat. I am slightly disappointed at the lack of enthusiasm for what is a very important injection of finance into two crucial areas of the NHS. Perhaps I may deal with the second area first; namely, cancer treatment. I have said several times in this House that we are not in any way breaching the question of additionality. I have made absolutely clear the extra funds that are going into cancer services and producing results in those services. The investment in breast cancer services are having a daily effect in reducing the amount of time that women wait for referral to consultants and increasing the coverage of one-stop clinics. We announced the process asking for bids for improvements to services for lung cancer patients. I was able to visit Papworth Hospital and see some of the things that are going on there. There are a number of exciting and innovative projects in colorectal cancer which have been funded through the £10 million that has been put into that area.

From my own experience of the NHS, I find it difficult to understand the way in which people seem to think that some kind of charitable contribution towards equipment in the NHS is an innovation. There is a long history of charitable involvement. Very few hospitals are so well-equipped that they have not held a scanner appeal. Very few hospitals have not benefited, particularly in the field of cancer care, from partnership with voluntary organisations such as Macmillan Cancer Relief. On Friday, during a visit to Leicester, I saw a magnificent building providing high quality cancer care. Large sums of money have been poured into that project. I met the Macmillan staff who were providing that care. There is a long-established tradition of Macmillan pump-priming for three years Macmillan Nurses, and of the funding then being taken over by the health service. They enjoy that commitment.

Of course the NHS must take on its share of the responsibility, as it does, for using such equipment and for providing the staff to ensure that it is properly used. However, we have talked many times during debates on the Bill that is before the House about the importance of equalising access to high quality care. We do not have that equal access at present. We have equipment that is terribly in need of replacement. This is an enormous opportunity to make a step change in the quality of care that is provided to cancer patients. It is an absolutely appropriate use of lottery money. I have no hesitation in saying that. Nor do I hesitate to say that I believe that that is the popular view among patients and the public in general.

I now turn to the £100 million that is being put in to improve accident and emergency services. I confirm that the noble Lord, Lord Clement-Jones, was correct. We are not talking about a further expansion of NHS Direct. I repeated a Statement in this House about how that coverage is being extended in order for it to be up and running in the larger part of the country by December this year to deal with the Christmas and millennium period. With some of that money, we seek to build on that experience of providing easily available access for patients to advice and care in innovative ways. I outlined some of the ways in which that will be achieved.

The noble Earl, Lord Howe, asked which hospitals would benefit and how bidding processes would take place. I do not think that there will be a classic: bidding process. I believe that I made clear, particularly in relation to admission wards, that we have done some work to see what is needed through regional offices. We are confident that the money that has been made available will be enough to ensure that every hospital A&E department that needs it will receive the appropriate capital investment. Some have already benefited, or are benefiting, from the £30 million NHS modernisation fund. Therefore, not every hospital is in need of investment. However, a large number do— perhaps up to 100. We believe that that investment can be made possible by this money.

I take the point made by the noble Lord, Lord Clement-Jones. It is not just a matter of capital investment. We are examining ways in which we can ratchet up the quality of care through investing in infrastructure. In some areas that is straightforward—for example, in security. In others, it provides the opportunity for re-engineering and ensuring that staff can provide more efficient and effective services by improving access to pathology or radiology, space for nurse practitioners, and the things that go hand in hand with providing appropriate services.

A&E services are central to the functioning of the whole system throughout a hospital. If we get those services right, we take a great deal of pressure off other parts of the service. I have seen, and I am told by admissions units that a large proportion of their patients are discharged straight from the admissions unit rather than having to be admitted to a ward and benefit from that speedy concentration of resources. It is therefore clear that the impact of providing that extra space, rather than taking space away, can have a crucial effect on the working of the whole hospital.

It is in that spirit that we have taken forward the issue that the noble Earl raised about trolley waits by setting up the emergency services action team to look not simply at trolley waits, which are often a symptom of a problem, but at the whole range of emergency services, both in the hospital and outside.

The funding is £100 million of new money for the NHS. The £2.5 billion capital modernisation fund was set up in the Comprehensive Spending Review to support capital investment to improve public services. It initially provided £1 billion for spending in the year 2000–2001 and £1.5 billion in 2001–2002. It was announced last week that the Government now believe that there is scope for a more rapid start in these key areas and that they have brought forward £250 million of the fund from 2001–2002 to 1999–2000. The CMF allocation is now £0.25 billion in 1999–2000, £1 billion in 2000–2001 and £1.25 billion in 2001–2002. I hope that that clarifies the position as far as the capital modernisation fund is concerned. As far as health service expenditure is concerned, this is all extra money.

7.30 p. m.

Baroness Pitkeathley

My Lords, in thanking the Minister for repeating the Statement, perhaps I may declare an interest as chair of the New Opportunities Fund, which will be responsible for distributing the money. In that role, perhaps I may assure the House that my board and I are completely committed to the principle of additionality, which the Minister mentioned.

Does the Minister agree with me that the best way to ensure that people recover from cancer is to have, first, early diagnosis and, secondly, public awareness and that, while it is very important that all hospitals have diagnostic equipment of the highest quality, equally as important is the provision of information to patients and their families about early symptoms and lifestyle—in other words, a holistic approach to detection, prevention and treatment of cancer?

Baroness Hayman

My Lords, I am happy to agree with my noble friend. The principle of additionality is one that is being safeguarded. While we envisage that, because of the importance of early diagnosis, a significant proportion of the money will be spent on equipment in the first year, that is not exclusive. I mentioned the provision of palliative care. My noble friend referred to the valuable role that information centres and information services can provide. That is something that we shall want to look at when considering the bids from individual localities. Those bids will take account of priorities but will also be able to look at the whole patient journey rather than simply at one area of expenditure.

Baroness Cumberlege

My Lords, the Minister said that between £20 million and £30 million would be made available for further developments in direct access, including services in main streets or shopping malls. Can the Minister tell us a little more about that? I suspect that it is related to the weekend press reports that the Government are to encourage Boots the Chemist to establish GP centres in pharmacies. I have no objection to that in principle provided there are certain safeguards, but, if this is to be the trend, it is a huge change in the philosophy of the gatekeeper role of GPs in a given community. It also challenges the idea of registered patient lists. I should like to know how it will affect the payment of GPs. Have the Government a strategy for this or will it be left to serendipity and commercial initiatives? I am not critical of it, but I should like to know what the Government's long-term strategy is towards these kinds of developments.

Baroness Hayman

My Lords, as I said in the Statement, these are innovative areas that we are looking at, building on the success of NHS Direct. I have to say to the noble Baroness, as I should have said to the noble Earl, Lord Howe, that I do not have responsibility for what is written in the press about the health service, which is not always of the highest level of accuracy.

The Government want to look at ways in which we can provide services in places and at times which are particularly convenient to patients. Part of that will be building on information services and perhaps providing those services perhaps in different places and through different media from those where they have been provided before. In A&E departments, in particular, it may be about providing treatment and care there and then—for example, by extension of out-of-hours GP services.

As far as developments outside traditional healthcare settings are concerned, the important thing is that we go with the grain of how people now live their lives and how they expect to have access to services. However, we recognise some of the points to which the noble Baroness referred. General practice is a jewel in our crown which we would not wish in any way to undermine by these developments. We need to take a careful and considered approach and work with the professionals, as we have worked with them on NHS Direct, to ensure that the new services that are provided are complementary and do not in any way undermine the services that already exist.

Baroness Masham of Ilton

My Lords, I welcome the Statement and should like to ask the Minister whether there is any hope that some of the extra money will go towards helping to prevent the spread of infectious diseases. The Minister knows what a problem MRSA is. Is there any hope of speeding up the tests for infectious diseases? Does the Minister agree that it is no good having wonderful new equipment if patients become ill in hospital?

Baroness Hayman

My Lords, I agree with what the noble Baroness says. I accept that in A&E departments when there are, for example, trolley waits in crowded circumstances, there is not only a risk of cross-infection, to which the noble Baroness referred, but also of pressure sores and a variety of other matters, including the privacy and dignity of patients, at a most stressful time, not being properly safeguarded. That is one of the reasons why we shall focus in particular upon medical assessment units, which will provide speedy diagnosis and consider the opportunities for isolation facilities, as appropriate.

Lord Winston

My Lords, the Government are to be congratulated on what is a very worthwhile initiative in two most important areas of medicine. The principle of using lottery money must surely be right and appropriate. It follows a model widely used—for example, the use of charitable money to such great effect in the United States for healthcare.

I wonder whether the Government have considered the possibility of using some of that money in the future for the kinds of services which are much more difficult to fund in the National Health Service. I am thinking in particular—and this is admittedly special pleading—of reproductive services. Will the Government give some thought to allowing some part of that money to be used for that purpose? In his Budget Statement the Chancellor made a great plea for the family. I am sure that my noble friend will agree that reproductive services are an important part of general health.

Baroness Hayman

My Lords, I always give thought to suggestions that my noble friend makes. I suspect that I should lay myself open to criticisms far worse than those I have received today about the funding of mainstream services if I gave him any further assurances. I understand exactly the connection that my noble friend makes and of course undertake to discuss it with colleagues.

Lord Rowallan

My Lords, while I welcome the extra funding for accident and emergency, which is the front line, I have two questions. There is to be £100 million of lottery funding this year plus £50 million over the next three years, making a total of £150 million. As all citizens of Great Britain together put money into the national lottery how, with devolution, will those funds be distributed to the different parts of the country? Presumably the money must be given to Scotland, but not for specific projects.

The Hampshire Magpie scanner appeal has been working hard to raise money. Can the Minister confirm that the main idea is to augment funds that have already been realised or to have completely new scanners, and so forth? Which will have higher priority?

Baroness Hayman

My Lords, priority will very much depend on regional cancer leagues informing us of their priorities. For some, the priority will be to replace equipment. Others will want added capacity. We need to view the matter from the patients' perspective, to ensure speedy access to effective treatment. There is no one answer but we should look at the output in terms of what the patient sees from the investment. Like the noble Earl, Lord Howe, I thought of my noble friend at Christie Hospital and how he would have reacted to the possibility of investment.

The noble Lord, Lord Rowallan, referred to how the funds would be split between the four countries. The £150 million for the UK as a whole, excluding administrative costs, will be allocated in such a way that over time, 77.5 per cent. will be committed to projects in England; 11.5 per cent. in Scotland; 6.5 per cent. in Wales; and 4.5 per cent. in Northern Ireland.

Lord Skelmersdale

My Lords, I have no quibble with using lottery money for capital equipment in the National Health Service. That is the right way to proceed. As many have said, including the Minister, it is an adjunct or fillip to what goes on. My noble friend Lord Rowallan mentioned a scanner in Hampshire.

The Government have three priorities for the health service this year, They are cancer, cardiac treatment and—it was a surprise that my noble friend did not mention this—mental health. In this additional tranche of money that the Government have courageously provided, just one of those priorities is singled out. Why could not the money be spread a little more thinly and appropriately, according to the Government's own priorities?

Baroness Hayman

My Lords, we have made it clear that, in terms of lottery funding, expenditure was on cancer services, where we felt there was a need for the catch-up exercise—particularly in respect of equipment. The noble Lord rightly draws attention to other priorities. One is mental health, for which the national service framework is being drawn up and substantial additional funds have been allocated. We have ring-fenced additional funds for mental health. We are currently working too on the national service framework for coronary heart disease, where I am examining the resourcing implications. It is important to acknowledge that demand but there are demands also for the drugs budget and public health areas such as smoking cessation support, which will have a great effect in respect of coronary heart disease. I do not think that we are neglecting those two areas.

Baroness Emerton

My Lords, I also welcome the funds that have been allocated, and particularly the emphasis that my noble friend the Minister placed on the importance of accident and emergency departments and admission beds. Having just personally experienced the upgrade of A&E departments and the introduction of admission beds, I know that the Statement will be much welcomed throughout the NHS.

However, while an A&E department is being upgraded, use of it is halved; that creates pressures, particularly in the winter, and makes life difficult for nursing staff and patients. It increases trolley waits and other pressures in the department. While trying to deal with the government initiative to reduce waiting lists, one must acknowledge the pressures created when money has to be spent over time.

Baroness Hayman

My Lords, my noble friend gives wise advice. Anyone who has lived through the major upgrading of an A&E department knows exactly how disruptive that can be for staff and patients alike. She is right to say that upgrades should be timed carefully and not at the peak of demand. A variety of smaller schemes will not necessarily involve the same disruption and could be successfully progressed. The carrot of knowing that new facilities will be made available takes people through the sticks of adversity and living with the builders.

Lord Warner

My Lords, I also welcome my noble friend's Statement. Does she agree that one of the greatest concerns of recent years has been the number of assaults on NHS staff and that a significant proportion have occurred in A&E departments? Will her Statement lead to a significant improvement in the security arrangements for staff working in A&E departments and will there be close co-operation between NHS trusts, community safety officers and the police?

Baroness Hayman

My Lords, my noble friend is right to draw attention to that aspect. Additional security facilities were among the priorities in the additional investment of £30 million from the modernisation fund. He is right to say that A&E departments are a particular flashpoint, which can create danger and distress for staff and patients alike. We must ensure that improvements are made in closed-circuit surveillance, and that is provided for in some of the schemes. My noble friend is sensible to suggest that local police services are involved in examining how that can best be done.

As well as the specific expenditure focused on security, other measures will include improving services overall, cutting waiting times and improving the quality of the surroundings in which people wait, and reducing access times to radiology and pathology. Improvements will reduce stress levels and, hopefully, levels of violence against staff and patients.

Baroness Gardner of Parkes

My Lords, I have a similar line of questioning to that of my noble friend, Lady Cumberlege, but we arrived at our questions quite separately. I have a particular interest in GP work in main streets and shopping malls. In Australia this occurs almost everywhere. The system of funding the health service in Australia is very different. Patients choose where to go and then reclaim what they have paid according to means after the event. That is a real test of patients' choice. They have greatly welcomed the provision of surgeries in shopping malls, to the extent that they have been expanded enormously.

As I understand the Minister, the service is intended to be free to the patient. I ask that question again. It is said that it will be at places and at times convenient to the patient. We would all like that. But the statement that this is not intended to replace general practice but to augment it may give rise to some risk. If patients take to this free service in a big way there will be a great demand for it. If a patient goes to a doctor in a shopping mall and the doctor gives a prescription—my noble friends have already asked how he will be paid, and, presumably, it will be done on a sessional basis—from whose budget will that come? How will it be fair either to general practices or to any other source? How will it be allocated?

Baroness Hayman

My Lords, the noble Baroness asks exactly the questions to which we must work out the answers together with the professionals to ensure that the services that are offered—for example, general practice in the high street—are properly and effectively run. I believe that I made clear that initially the provision of direct services is more likely to take place in an existing NHS setting. That is one of a number of options that we are considering to improve access to high quality care. It is too early to provide the details. We have set out the direction of travel.

But we should not think only of GP services. We must build on the work that is done by community pharmacists. That is an issue about which we have spoken in your Lordships' House on many occasions. People place faith in pharmacists to provide well-informed advice, particularly on the treatment of minor ailments. We want to see the role of pharmacists generally and community pharmacists in particular extended. Not to make full and proper use of their skills and knowledge is a waste of a highly effective resource that can provide exactly the easy access to services in the high street about which we have been speaking.

Lord Hoyle

My Lords, I beg to move that the House do adjourn during pleasure until 8.35 p. m.

Moved accordingly, and, on Question, Motion agreed.

[The Sitting was suspended from 7.52 to 8.35 p. m.]