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Several hon. Members rose

Mr. Deputy Speaker: Order. This is a very important matter and many hon. Members are seeking to catch my eye. May we please have shorter questions, and perhaps shorter answers?

Tony Wright (Cannock Chase): On any test, this is a defining moment for the health service, and I congratulate the Government on what they are doing. People simply have to make up their minds: do they want to rebuild the health service, or not?

The Secretary of State talked about giving a guarantee to heart patients who face a wait of more than six months, and about introducing a true insurance approach to the health service. Under such an approach, people pay in and they know what they will get out. In talking about making step changes and step improvements to bring down waiting times, can we not tell people that that is a commitment? Can we not say, "A commission will ensure that we do that, and we will give real patient guarantees, so that we know what you have paid in, and you know what you will get out"?

Mr. Milburn: On my hon. Friend's first point, the decisions relating to the Budget and the reforms were of course important. The simple observation—I hope that it is widely shared—is that if people want world-class health care, it has to be paid for somehow. The issue is not whether we pay for it but, I suppose, how. The argument and debate about that will continue in the weeks, and perhaps years, to come. When people examine the issues carefully—as we have done, and as the British Medical Association did in 2000—they will conclude, not on the ground of destabilising the current system, but on the grounds of principle and of values, that the national health service is the right way forward for the country. However, we must ensure that we grow the capacity, and I am afraid that we must make some big changes.

We want to grow the capacity in stages. The biggest capacity constraint is the shortage of qualified staff, be they doctors, nurses, scientists or therapists. We must be

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straight and honest with people: it will take time to grow capacity. It is no use the Opposition yelling about a 10-year plan. Yes, it is a 10-year plan, and it will take time to get there. As we improve services and cut waiting times, the offer that we can make to individual patients will of course improve. However, it is important that people understand that an enormous pot of money is now going into the national health service, but that it will be released in stages. We have to ensure that the NHS works for patients, and we will improve the services that they use progressively, rather than overnight.

Mr. Michael Jack (Fylde): The Secretary of State has put great store by his improved audit arrangements, but who will set the criteria by which success will be judged? Will the auditors set it, or will he set it? In his statement, he also mentioned improvements in waiting times, but not for the first consultant appointment. What will he do to reduce targets for that?

Mr. Milburn: The right hon. Gentleman will be aware, as a Treasury Minister in a previous Conservative Government, that the Audit Commission works very independently. It has done a first-class job and its integrity and independence must be maintained at all costs in the new system. It decides what value-for-money studies it wishes to undertake and, similarly, the new commission will decide which studies it wishes to undertake. There are two forms of standard setting, including the new national service frameworks for cancer, coronary heart disease and mental health, which are drawn up between the Government, the NHS, clinicians who work in the NHS and patients who use it.

On the subject of out-patient appointments, I did mention the cuts in waiting times for in-patient treatment that are taking place. Getting the waiting times for out-patients down has been a long haul, but they are now down below the level that we inherited. As we grow the capacity, put the extra resources in and—crucially—make the reforms, we will continue to bring waiting times down so that by 2005 no one will wait more than three months for an out-patient appointment either.

Dr. Brian Iddon (Bolton, South-East): Bolton has welcomed the considerable amounts of money that we have received for our health service and our social services department, but a problem remains. In 1997, we were 6 per cent. away from target funding. A letter that I received this week from the Under-Secretary revealed that the new primary care trust began its work 6.02 per cent. away from target funding, so the situation has not improved. I seek assurances for my constituents from my right hon. Friend that in the next five years the real inequalities that exist in areas such as mine will be addressed once and for all.

Mr. Milburn: My hon. Friend will be aware that a review of the way in which we distribute resources is being conducted, both in local government and in the NHS. As I have said before, I cannot give an absolute assurance for Bolton, but I recognise that the area has its fair share of problems, with high levels of morbidity and

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deep health inequalities. Our new formula for distributing growing NHS resources is designed to address such problems.

Mr. David Curry (Skipton and Ripon): Will the Minister cast his mind back some five years, when the Labour Government introduced a whole new inspectorate system for local government called best value? That immense gendarmerie is now so complicated and complex that his Government are saying that they must start to dismantle it. What assurances can he give us that the inspectorate that he has announced today will not be such an enormous consumer of management time that it will divert people from the task of looking after patients? Does he realise that he has now announced a sort of amalgam of nationalised and local responsibility, so that nobody will any longer have the faintest idea of where the buck stops? Can he decide whether he or the people who know about it are running the NHS?

Mr. Milburn: For once, the right hon. Gentleman is remarkably confused on the issue. Normally, he is a beacon of light in a sea of darkness on the Opposition Benches. The position is clear. We will not have three bodies inspecting and regulating health care in our country. Instead, one body will inspect and regulate health care to common national standards, whether in the public or private sector, in primary care or in hospital-based care. Nobody, with the best will in the world—even someone with the right hon. Gentleman's creative accounting mind—can possibly make that add up to more bureaucracy when it will mean less bureaucracy.

The right hon. Gentleman knows as well as I do that we must get the right balance of national standards in a national health service, because the last thing that we want to do is to return to the position that the Government inherited in 1997, when there was a lottery of care for cancer services and drugs. We have put that right. What we have recognised, as I have been able to announce today, is that services have to be delivered locally. We need greater freedoms and more rewards for the best. We must step in where there are problems, but we must step back where there is progress.

Mr. Eric Illsley (Barnsley, Central): Barnsley has exactly the same problem as Bolton: we are moving further and further away from our target funding, and that means a £6 million shortfall, which the primary care trust must address. I very much welcome what my right hon. Friend has said about the independent audit, but will it be empowered to compare health authorities throughout the country in order to show exactly where value for money is delivered, so that in areas such as Bolton and Barnsley, which administer their funding very well, we can benefit from the extra resources going into the service?

Mr. Milburn: The straightforward answer to that question is yes. That is precisely what it will be doing, so that people both locally and nationally, and particularly in this House, have an opportunity to judge how well different health services are doing in different parts of the country. That is a welcome step forward and a recognition that the national health service belongs not to me or even to the people who work in it, but to the British public, who have a right to know how well it is doing.

Rev. Martin Smyth (Belfast, South): The Secretary of State is well aware that health matters have been devolved

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to Northern Ireland and Scotland. Can I have an assurance that the increase in health service funding will be allocated at the same level in Northern Ireland? I have to raise the issue because this is a national health service, and over the years Scotland, Northern Ireland and England have shared the situation, providing doctors, nurses and specialists.

I want also to press the Secretary of State on whether he is absolutely sure that there will be less bureaucracy under the independent inspection—or will fewer people do the job, which has not been done well in the past, and we will continue to suffer? The British people are the jury. They have been long-suffering, but are beginning to turn and become more demanding. They will still be demanding if we do not deliver.

Mr. Milburn: It is not really my responsibility to comment on issues either to do with Northern Ireland or to do with finance in Northern Ireland. However, my understanding of what my right hon. Friend the Chancellor of the Exchequer said yesterday is that the funding increases are not just for England but for other parts of the United Kingdom.

Inspection and ensuring that we have the right number of people in place is more than anything else a matter for the new independent commission; that will not so much be a matter for me. It must decide on the level of resources and the number of staff needed in order to do the work that it needs to do, which is about improving standards and accounting for where public money is spent.

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