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Lord Cope of Berkeley: My Lords, I am grateful to the Minister for taking up the point I made in Committee and moving his amendment. We move from a matter of principle to nitpicking over the wording. The noble Lord says that his amendment is wider, but I am not sure about that. Let us suppose that organisation A claims to be on ceasefire, but it becomes known to the Secretary of State that those in charge of its store of weapons, ammunition and explosives are allowing them to fall into the hands of organisation B, which is not on ceasefire. The only reason for organisation B having the weapons will be because it is planning violence. I believe that that action would slip through the Minister's new wording, which concerns me. However, if my wording were applied, such action would cause both the organisations, A and B, to fail the test.

Nevertheless, we should not nitpick too much across the Floor of the House when we are agreed on the principle which lies behind the issue.

On Question, amendment agreed to.

[Amendment No. 7 not moved.]

Health Expenditure

The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, with the leave of the House, I should like to repeat a Statement being made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:

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    "A three-year settlement allows the NHS to take a longer term view. Now that funds are guaranteed for three years, for example, there should be no more systematic use of short-term employment contracts for nurses and other staff. That will provide security that they do not have at present.

    "A modern health service requires modern buildings and modern equipment. Over recent years, the NHS has been starved of capital. We are putting that right. That is why as part of the modernisation programme £8 billion will be invested in new hospitals, clinics and GP premises. Thirty new hospitals are already planned. Work is already under way at Dartford and Gravesham, Norfolk and Norwich, Carlisle, High Wycombe, Durham, Sheffield, Amersham and Greenwich. There will be more to come. But new and better buildings will not be confined to the places getting new hospitals. We will be increasing public sector capital by 50 per cent.

    "Hospitals in every part of the country will benefit. Hundreds of wards, A&E departments and operating theatres will be refurbished. And every year outdated equipment will be replaced with the newest and best medical science can offer.

    "And we are investing in primary care. Over the next three years 1,000 GP surgeries will be improved or rebuilt.

    "A modern health service requires earmarked cash to make change happen. I can announce today that the £18 billion settlement for England includes a £5 billion-plus modernisation fund. This money will be strictly targeted on helping NHS staff to transform the NHS into the kind of service both they and we want to see: a service which is fast and convenient; a service which has uniformly high standards; a service which is moulded to the needs of patients.

    "The modernisation fund will fund the IT revolution. It will go towards making sure that we meet the reductions in waiting lists to which we are committed. We will also use money from the modernisation fund to make a start this year on introducing booked admissions, so that when a patient is told by his GP that he needs to attend an outpatient clinic he will be able, there and then, to book an appointment which suits him. Similarly, if a patient has to have surgery as a day or in-patient, he will be able to book an admission date which suits his needs and family and work requirements.

    "Besides contributing to the refurbishment of hospitals and the building of new GP premises, the fund will help buy new equipment. It will support the promotion of good health. It will pay for better training of NHS staff. It will provide modern and effective mental health services. The modernisation fund will be allocated to finance well worked out plans and proven mechanisms for improving services. It is investment for reform.

    "A modern health service requires modern ways of working. By getting rid of the wasteful and divisive competitive internal market, we are taking money out of the bureaucracy and into patient care. Primary care groups involving doctors, nurses and social services

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    will replace the maze of commissioning and fundholding organisations. NHS management trusts will be amalgamated. Competition between hospitals is being ended. They are working together again. They will continue to do so. The NHS is proudly already the most cost-effective healthcare system in the world. But there are unacceptable variations in performance. Management effort will be targeted on hospitals where costs are above the national average. A new performance framework will help measure progress. Our value-for-money improvements should release a further £1 billion a year for patient care. So there will be a tough drive on genuine efficiency. That means more money for patients, more money for staff and better value for taxpayers.

    "A modern health service also requires a new relationship with social services. We have made a start on breaking down the Berlin Wall between the NHS and social services.

    "To back that up, over the next three years we are providing an extra £3 billion for social services so that they can match, complement and augment what the NHS is doing--an increase of 3.1 per cent. in real terms, year on year. So for the first time they will be able to produce joint local long-term plans with the NHS. And for the first time we will be setting tough efficiency targets for all social services authorities to help them deliver the goods for vulnerable people. It will mean better help for the elderly and for carers. There will be new measures to allow tens of thousands of old people to live an independent life, where at present they often end up trapped in nursing homes or in hospitals. And it will mean more help for people with mental health problems to match the extra NHS commitment to mental health.

    "Arrangements for looking after children in care have far too frequently been deplorable, with children being molested, with low levels of school attendance and educational attainment. Many of them have been turned out of care to fend for themselves when they are little more than children. We are determined to give them a new deal and the extra social services money will provide the money necessary to improve the quality of care received by children living away from home. And not before time.

    "All this effort, all this investment is intended to deal properly with people when they need treatment and care. But this Government are not satisfied with a health policy just for treating the sick. We want to stop people getting ill in the first place and stop people dying prematurely. And we want to tackle the growing inequalities in health.

    "That is a job for the whole Government, not just for the Department of Health. This CSR settlement is not just a good settlement for our health service; it is a good settlement for our people's health: £540 million for the Sure Start children's fund, almost £4 billion to invest in decent housing and improved insulation, £3 billion for deprived communities, £1.7 billion for transport, and mostly public transport. And that is on top of our earlier commitment to the £3.5 billion New Deal for jobs

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    and our introduction of a national minimum wage. What all this amounts to is the biggest health crusade the country has seen since the NHS was born 50 years ago--a modern, government-wide crusade.

    "The NHS was founded on a simple principle: care should be provided on the basis of need. That principle has served the NHS well for 50 years.

    "While we were considering the CSR we were urged by all sorts of people to abandon this principle: by some of the honourable Members opposite; by the Social Market Foundation; by the Adam Smith Institute; by many of our newspapers; by various professors. They wanted us to charge people for going to the doctor. Charging to see a GP. Charging for outpatient appointments. Charging people for going into hospital. We have looked at all of this very carefully. We have looked at all the pros and cons. We have spent the best part of a year doing it. We utterly reject these ideas. We have rejected them because they would not work and they would harm the worst off. Charges would be expensive to collect and would glean little overall revenue. Most important, charges would deny treatment to those who need it most. So I can announce today there will be no new NHS patient charges in the lifetime of this Parliament.

    "And we have not stopped there. From next April the NHS will provide free eye tests for pensioners. This will be good for their purses and pockets, good for their sight and good for their general health.

    "This is an historic settlement. It will enable the hardworking and dedicated staff of the National Health Service and social services to provide the treatment and care that people need and to provide it to a higher standard than ever in every part of the country. It will modernise and renew the NHS. The extra money will be matched by enormous changes and improvements.

    "Over the last few weeks we have been celebrating the 50th anniversary of the NHS. That was right and proper. But now we must do as the founders of the NHS did. We must look forward; find the resources; and make the changes that are necessary to relaunch the NHS so that it serves our country well for the next 50 years. Nothing less will do, and that is what this Government are doing."

My Lords, that concludes the Statement.

5.15 p.m.

Lord McColl of Dulwich: My Lords, I thank the noble Baroness for repeating the Statement. Of course, we welcome the promise of extra funds for the NHS, provided that they are based on sound money.

The Government's claim that an extra £21 billion will be available for the NHS over the next three years is an extremely interesting piece of creative accounting. We welcome the proposed increase in the number of nurses and doctors, although recruitment of nurses has been a great problem, even though the money has been there.

To be more specific and down to earth, will the Minister tell us what she proposes to do about the 300 fully trained obstetricians who are waiting for consultant

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posts? Will she ensure that many more consultant posts are created for them? Will she tell us when she thinks that will be?

Does the Minister accept the figures produced by the House of Commons Library which show that the extra money from the comprehensive spending review over the conservative real growth trend of 3.1 per cent. is just over £2 billion, which is a very long way from the £21 billion that is being claimed?

Furthermore, is it now the case that the independence has been taken out of the Independent Pay Review Body and that its recommendations are now subverted to Treasury considerations? If that is so, it will be a betrayal of the principles of such review bodies. How will the Minister react to the British Medical Association's objection to any unilateral attempt to undermine the fairness of pay review bodies?

The Independent newspaper today states that this is not the largest real terms three-year increase in the history of the NHS as asserted by the Chancellor. It is in fact below the 5.6 per cent. that we spent between 1990 and 1993.

Will the Minister tell us how much the millennium bug programme will cost the health service? I believe that the Audit Commission estimated that it may be as high as £850 million. What will be the cost of the minimum wage to the NHS? How much will the abolition of compulsory competitive tendering cost the NHS? How much will the abolition of tax relief on private medical insurance for the over-60s cost the NHS in terms of extra work?

Finally, when we subtract all those figures from the extra £2 billion and also allow for inflation and the costs of administering each of the primary care groups, it seems to me that there will be only a few hundred million pounds left, which is barely enough to run the NHS for a week.

To be fair to the Government, perhaps they are hoping for some surprises for the NHS. We sometimes have completely unexpected results from medical research. For example, Viagra was designed originally to relieve angina but it did not work. The doctors were therefore extremely surprised that the male patients who were given the drug seemed somewhat reluctant to give it back. Perhaps the Government are hoping for a similar piece of luck to give them some surprises.

5.19 p.m.

Lord Newby: My Lords, we, too, welcome the Statement. Naturally we welcome the additional funding which forms the heart of it, but we would have preferred it if the Government had felt able to make some of that funding available earlier rather than later. Nevertheless, we are pleased to see that there will be significant extra funding from the next financial year. We specifically welcome the proposal for free eye tests for pensioners, although we believe that such a preventive test should be freely available for all ages. Indeed, the maximum benefit of such tests is that they should be available freely at the point when the problems first arise. We

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also believe that the principle of free eye tests should be extended to dental checks and again that those checks should be available to everyone.

However, we are less impressed with the proposals to ratchet up prescription charges and are somewhat surprised at this given the fact that when in opposition the Labour Party described such increases as a "tax on the sick". We would have frozen them at their present level and regret that the Government did not take this opportunity to do so.

The Statement raises a whole raft of questions, but the House will be pleased to know that I shall not attempt to cover all of them. However, there are one or two points that I should like to mention. We obviously welcome the increased provision in staff numbers. However, given the fact that unfilled vacancies at present amount to some 10,000, of whom 8,000 are nurses, how confident is the Minister that on current levels of pay higher target levels of staffing will actually be met? How confident is she that we will not find that higher staffing levels are at least partially matched by higher unfilled vacancy levels?

Moreover, on the question of pay, given the stricter terms of reference that have been given to the pay review bodies, can the Minister confirm that the Government will in future implement their recommendations in full from the start of the relevant financial year and not stage them, as has been the case both under the previous government and so far under this one?

I turn now to waiting lists. Before the election, the Government said that they would be spending £100 million to take 100,000 people off waiting lists. The Statement says remarkably little about waiting lists. Given the fact that the Government are actually spending an extra £21 billion in their terms rather than the extra £100 million that they were talking about in terms of waiting lists before the election, can the Minister say why they have not set a target? Indeed, we would have suggested a six-month target within which all patients requiring serious operations would be treated. Can the Minister also say whether further progress can be made beyond what is in reality a relatively modest waiting list target that the Government have set and, because of their parsimony to date, have so far failed to meet?

I conclude with a slightly broader question as regards the extent to which the extra funding available could offer a much wider range of services for seven days a week and 24 hours a day, rather than just for the working week. It is a cross that the Minister has to bear in her current portfolio that everyone uses the NHS and, therefore, has his or her own bit of experience to relate. I am afraid that this is the point at which my little bit of recent experience is brought to bear. I had to take my son, with a broken wrist, to the John Radcliffe hospital on a Saturday a few weeks ago. We had to wait for hours to be seen at the fracture clinic because there was only one doctor on duty. Thereafter, we had many more hours of waiting for my son to have a minor operation because only one operating theatre was staffed. We were told that, if we had been there on a "working day", the

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levels of staffing would have been significantly different. In that area--and, indeed, in many other areas of care--it is the case that in all too many instances the quality of treatment depends on exactly when a person is taken ill. What assurances can the Minister give that this unacceptable state of affairs will now effectively be addressed?

5.23 p.m.

Baroness Jay of Paddington: My Lords, I am grateful to both noble Lords for their response to the Statement, although I have to say that their financial arithmetic leaves even me--not the world's greatest expert in mathematics--somewhat adrift. Perhaps I may explain to your Lordships that £3 billion will be put into the health service next year, £6 billion will be put in the year after and £9 billion the following year. That adds up to £18 billion. If we then add the £3 billion for social services, the total figure is £21 billion and not £2 billion or £2.1 billion--or whatever it is that members of the Conservative Party seem to have agreed as the figure they wish to bandy about. One wonders whether they have added an unexpected decimal point between the two and the one thus enabling them to come up with such a figure. However, let us assume that we can agree that substantial sums of money are being put into the health service, that this is new money and that substantial sums are also being put into the social services budget, which is also new money.

Both noble Lords raised the question of the independence of the pay review bodies. Those bodies will continue to have the independence that they have always had. As I said when repeating the Statement, we have tried to make explicit what has always been implicit in their considerations. Obviously, if one is looking at pay for a large number of people in the public services, the current economic position of the economy as a whole has to be taken into account and, indeed, the current performance of the service to which the pay review is applied. But that does not in any way undermine the independence of those bodies. My right honourable friend the Secretary of State repeated in another place earlier this afternoon that he will certainly wish to ensure that he will not have to pay staged pay review recommendations in the future. I am sure that that is something that he will adhere to as far as he can.

The other points made by both noble Lords related to the quality of the service. It is true that there are problems as regards shortages of doctors and nurses of the type referred to in relation to the particular experience at the John Radcliffe hospital. However, I should tell the noble Lord, Lord Newby, that it is wrong to imply--and certainly unnecessarily critical of the many millions of people who work 24 hours a day in the health service, whether in primary care, in emergency services or indeed in our hospitals--that the NHS is not now a 24-hour service. Indeed, it is.

Precisely what we are trying to do by expanding the number of people in the medical and nursing professions is to provide better cover, better services in accident and emergency and a more rapid response to the kind of problems that the noble Lord experienced. No one would protest that the health service cover at present at

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the week-ends or during the evenings was total and perfect. But to suggest that the NHS is not a 24-hour service now is to undermine confidence in the quality of the work which is carried out for seven days a week.

The noble Lord, Lord Newby, also raised the question of waiting lists. The £500 million already agreed in the spring Budget has been targeted directly to reducing the number of people on waiting lists. Again, as my right honourable friend the Secretary of State has announced, waiting lists are now beginning to go down and they will continue to do so. Indeed, they will go down for the remainder of this Parliament. Of course they remain a priority, but not within the context of the modernisation fund to which I believe the noble Lord was referring. That is more specifically targeted towards the kind of improvements in the service that I listed when repeating the Statement.

The noble Lord, Lord McColl, raised specific questions about the year 2000 and about the provision for people who fall within the minimum wage category. I can tell the noble Lord that the provision which has been agreed and which has, as I understand it, now been accepted as appropriate for the health authorities for remedying the problems with the year 2000 so-called "millennium bug" was already included in those budgets and, therefore, does not require new money. On the question of the minimum wage, I can tell the noble Lord that we have agreed that it will take up approximately £20 million of the NHS budget. We believe that to be entirely appropriate and simply regret that there are that number of people working within the health service who fall within the category and need the protection of the minimum wage provision.

5.28 p.m.

Lord Bruce of Donington: My Lords, it is a particular pleasure for me to be able to congratulate my noble friend the Minister and the Government on these new national health proposals. It is only 50 years ago since I sat on the second Bench opposite, when the other place was sitting in this Chamber. I sat behind my chief, Aneurin Bevan, while he went through his introduction to the Bill which was thereafter translated into the National Health Service. There is an awfully long way to go. Those of your Lordships who have seen the recent OECD report on health in various countries throughout the world will know that the United Kingdom comes 22nd from the top of the list of expenditure expressed as a percentage of GDP. In Germany, for example, 10.5 per cent. of GDP is spent on health. In the United Kingdom, the figure is 6.9 per cent. I repeat that we are 22nd on the list. There is a long way to go. I feel confident that the Government will be able to go that far. Certainly on the basis of the OECD figures, they cannot consider any capping of expenditure on the National Health Service.

There is also the commitment, which I welcome, and which I have long advocated, of a return to the nation's health being the responsibility of the whole of government and of all departments rather than relying on only the ministry of health and local authorities to deliver the service. It is quite clear from the Statement that the Government intend to use the other great

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departments of state to produce those conditions which encourage good health, which fight ill health and which, as a consequence, lower expenditure on the health service. This should be a proud day for the Government; it certainly is for me. For my part, I only hope that world economic and financial conditions are such as to permit the fulfilment of this commitment.


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