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House of Commons

Tuesday 16 July 2002

The House met at half-past Two o'clock


[Mr. Speaker in the Chair]


HSBC Investment Banking Bill [Lords]

Order for Third Reading read.

To be read the Third time on Tuesday 23 July.

Barclays Group Reorganisation Bill [Lords]

Order for Third Reading read.

To be read the Third time on Wednesday 24 July.

Oral Answers to Questions


The Secretary of State was asked—

Consultants' Contract

1. Mr. Chris Mullin (Sunderland, South): What assessment he has made of the effect of the proposed consultants' contract on their productivity; and if he will make a statement. [67264]

The Secretary of State for Health (Mr. Alan Milburn): May I say how pleased I am to see the hon. Member for Woodspring (Dr. Fox) in his place after the terrible and tragic events of the weekend? I am sure that all our thoughts are with him and all concerned.

The framework agreement that we have reached with the British Medical Association will increase the time consultants spend on direct clinical care. There will be greater rewards for those consultants who contribute most to the national health service. In crude terms, the more they do, the more they will get, so contributing to increases in NHS productivity.

Mr. Mullin: May I put it to my right hon. Friend that, although there are many dedicated NHS consultants, the profession is notorious for its pursuit of self-interest and self-importance? What safeguards are in place to ensure that consultants deliver, and what will stop them pocketing the extra money and moving on seamlessly to their next demand?

Mr. Milburn: A good start! I listen carefully to my hon. Friend in these and all other matters, but I have a slight difference of view with him on this issue. Most NHS consultants do a very good job of work for the NHS, and I should assure him that the new NHS consultants'

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contract is, in essence, a something-for-something deal. Obviously NHS consultants will get more, and we are prepared to pay them more, providing they are prepared to do more for NHS patients.

The deal that we have negotiated means, for example, that in future, NHS consultants' pay will be tied to their performance against their job plans. Their job plans are part of their contract of employment and, for the first time in the history of the NHS, that means that the NHS employer will be able to define when the NHS consultant works, and that includes getting an increase in direct clinical care for patients. The more consultants are prepared to do, the more rewards they will get.

Mr. John Redwood (Wokingham): Is it not the case that the productivity of doctors in the hospital service will decline as shorter hours are introduced? Is it not also the case that costs will rise sharply as pay becomes more realistic? Can the Secretary of State give us some idea of how much of the extra money over the next three years will go in rising costs and lower productivity as shorter hours are introduced for all doctors?

Mr. Milburn: I do not think that that is the case. In fact, as the right hon. Gentleman is aware from the public service agreement that we published yesterday, we expect a 2 per cent. increase each year in both efficiency and quality in the NHS as we expand it. It is certainly true that there are problems with productivity, particularly if the NHS does not expand. However, it is expanding precisely because of the choices that the Labour Government have made.

The choice that we have made is to put extra investment into our key public services, including the NHS. It is therefore incredible that the right hon. Gentleman and his hon. Friends should stand up and argue about productivity, efficiency or investment when they are committed to cutting that investment.

Mr. Kevin Hughes (Doncaster, North): What other group of workers wield as much power as consultants? Their so-called trade unions, the royal colleges, dictate how many consultants can be trained each year, where they can be trained and which hospitals can carry out what operations. They decide how many hours consultants work for the NHS and they keep waiting lists high so that people fork out money to jump the queue that they have created. Will my right hon. Friend tackle this closed shop, which makes Bob Crow and the RMT look like a set of woolly liberals?

Mr. Milburn: I think that that is what is known as a friendly question. As far as tackling the issue is concerned, my hon. Friend is aware of the terms of the framework agreement that we have reached with the BMA. Obviously that will now go out to consultation, and I presume that NHS consultants will have an opportunity to have a say on what they think about it. However, it will tackle many of the problems that he has outlined.

On my hon. Friend's point about closed shops, no one in the NHS has a right to prevent patients from receiving the sort of services that they require. We must ensure that we get more doctors into the NHS and get more use of the doctors who work in the NHS. He is aware that the issue of private practice has been unresolved for many

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years in the NHS, and the new consultants' contract of employment will resolve it once and for all by making it clear that the first call on their time and their first priority has got to be NHS patients.

Dr. Jenny Tonge (Richmond Park): Does the Secretary of State agree that the merit award system is one of the root causes for consultants developing the characteristics so beautifully described by the hon. Member for Sunderland, South (Mr. Mullin)? What plans does he have for revising that system?

Mr. Milburn: The merit, or distinction, award system needs to be reformed, and we are planning to do that, as the hon. Lady well knows. It is the next element of the reform programme and is under discussion. I want the merit awards to be precisely that: rewarding merit, especially those NHS consultants who do most for NHS patients. We trained them to do that and they are skilled experts. We have too few of them, but that will change. In the meantime, we need to ensure that we get more of their valuable time and skills for the benefit of more NHS patients.

Mental Health

2. Mr. Tony Lloyd (Manchester, Central): If will make a statement on the provision of in-patient beds for mental health patients in urban areas. [67265]

The Minister of State, Department of Health (Jacqui Smith): Each mental health service user who is assessed as requiring a period of care away from their home should have timely access to an appropriate hospital bed or an alternative bed or place. In the NHS plan, we set down our commitment to create 500 extra secure beds and 320 extra 24-hour staffed beds. We have met this target.

Mr. Lloyd: I hope my hon. Friend will tell the House that mental health, always the Cinderella of the health service, will have a fair share of the huge increase in spending on the health service, because that is vital. On a specific problem, the number of patients in Manchester—the figure is typical of urban areas—who have been sectioned under the Mental Health Acts now accounts for 50 per cent. of the beds occupied compared with only 20 per cent. 10 years ago. The problem is that patients have to queue up for in-patient beds. Unless we provide more beds to get the balance right, people will be given a bed only when they have reached crisis point. Beds need to be available earlier, when it is cheaper and better for the patients.

Jacqui Smith: My hon. Friend makes an important point about the priority previously afforded to mental health services. With the publication of the mental health national service framework and the NHS plan, the Government have made mental health one of the top three clinical priorities.

My hon. Friend also outlines the problem that occurred because of the low priority given to mental health and, of course, the low investment in it, which meant that there was a reduction over many years in the number of acute beds available. The Government are determined to turn around the investment and to give mental health the priority it deserves. The Manchester mental health and social care

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trust has received additional investment of £1.4 million from its commissioners this year, specifically to open 10 additional NHS beds and to strengthen community mental health provision with the implementation of a crisis resolution service in the city, which experience elsewhere suggests can lift pressure on acute beds. I agree that for too long there has been a lack of investment in, and commitment to, our mental health services. We are determined to put that right.

Mr. Robert Key (Salisbury): A month ago on 18 June I raised with the Secretary of State the crisis in the Avon and Wiltshire mental health partnership NHS trust. He said that it was all a matter of money. I wrote to the Minister on 29 April and she told me in a written answer that she would reply as soon as possible. Councillor Christine Reid, the Labour councillor who chairs that trust, has not replied to my correspondence. The matter is urgent. It is not party politics; it is process. In particular, it reflects a breakdown in the mental health system in south Wiltshire. If the Minister cannot answer, will she at least see me to explain why the trust has lost £60,000 for the alcohol and drug advisory service and how the Government expect the new trust to function with an initial deficit of £500,000?

Jacqui Smith: I apologise if I have failed to respond to the hon. Gentleman's letter. I will ensure that he gets an answer. I have discussed issues to do with that trust with its chair and I am willing to discuss progress in his constituency with him. However, part of that discussion may well concern the difference in our approaches to investment in mental health services. The Government have made it clear that we are investing more in those services and will continue to do so; but the hon. Gentleman, and in particular his Front-Bench colleagues, have opposed that investment. That would have to be part of any conversation that we had about how to improve our mental health services.

Mrs. Joan Humble (Blackpool, North and Fleetwood): Will my hon. Friend pay particular attention to in-service provision for children who present with serious psychiatric problems? All too often, they are inappropriately placed either on general paediatric wards or in adult mental health provision; they need their own specialist services, and I hope that my hon. Friend will consider the provision of such in-service beds.

Jacqui Smith: My hon. Friend raises an important point. Mental health services for children and adolescents were perhaps treated even more poorly than adult services by the previous Government when it came to showing interest and making investment. The £105 million of investment in child and adolescent mental health services has begun to bring those services out of the shadows and enabled us to develop the specialist provision, including in-patient beds, for which my hon. Friend argues.

My hon. Friend made an important point also about the inappropriate placement of young people in adult services. Sometimes that happens because local services have failed to plan the transition of responsibility from child and adolescent services to adult services. In the children's national service framework we will consider carefully how to take forward the work towards higher standards in child and adolescent mental health services.

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Sandra Gidley (Romsey): According to recent guidance from the National Institute for Clinical Excellence, the majority of studies show that the higher cost of purchasing atypical antipsychotics is more than offset by the reduction in in-patient stays. This morning, at a conference attended mainly by psychiatrists, more than two thirds of those present said that funding was a barrier to prescribing atypicals. How will the Minister ensure that adequate funding is provided to increase their prescription?

Jacqui Smith: The hon. Lady rightly points out, as do the NICE guidelines, the potential benefits for the service as a whole and for individuals of being able to prescribe atypical antipsychotics in the appropriate circumstances. It was to secure those benefits that we set up NICE to develop such guidelines and to involve users, which is another important way in which we develop our services. We are investing in our mental health services, and we have earmarked extra investment for service delivery and the development of new services.

Sandra Gidley indicated dissent.

Jacqui Smith: For Liberal Democrats the investment is never enough. The difference between sitting on the Opposition Benches and sitting on these Benches is that we make the decisions, we provide the investment and we set the priorities. We said that mental health was a priority; that is making a difference at a local level and I am confident that it will continue to do so.

Glenda Jackson (Hampstead and Highgate): Despite the excellent work that has already been done by the rough sleepers initiative, the condition of many mentally ill people in London is exacerbated by the fact that they are of no fixed abode. Given the peripatetic nature of their lives, it is not unusual for homeless people who are mentally ill to reach and pass the point of crisis and to find it impossible to gain any medical treatment. It is bad enough to be without a home, but surely to be denied access to the NHS is unacceptable. Will my hon. Friend please consult the Mayor's health commission to examine the additional needs for such services on a much broader than borough-by-borough basis?

Jacqui Smith: My hon. Friend makes an important point about the needs of the homeless. As we develop our mental health policies—in particular, the new community teams which, in parts of London, have been able to reach out to people in the community, even people without homes who have previously been unable to access services or have not be able to access those services early enough—I am happy to talk to anyone to make sure that they deliver improvements for the most vulnerable people cited by my hon. Friend.

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