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Baroness Jay of Paddington: My Lords, it is a great pleasure to me that my noble friend Lord Bruce of Donington is present this afternoon to draw on his extraordinary historic experience of the foundation of the health service. It is a great pleasure to me that he feels that the principles behind that are being maintained by the present Government. I can reassure him that we consider public health in the wider context of housing, air quality, the experiences of young children, and all aspects of economic life, particularly employment. Those are considerations which we feel are as relevant to health policy as the rather narrower concerns of the health service. I can assure my noble friend that we shall give those matters priority.

Lord Hayhoe: My Lords, the Minister knows of my interest in the hospice movement. Her support for hospices is equally well known. I do not think I heard in the Statement any reference to that important element within our health services. Will the Minister give some indication of whether the hospice movement generally will benefit as a result of the extra resources that are being made available?

Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord, Lord Hayhoe, for his comments. Both he and I have an interest in the hospice movement. Specific funding for the voluntary sector has not yet been agreed. However, I can assure the noble Lord that I am concerned that those great instincts and methods which have been pioneered by the hospice movement in palliative care are extended and included in the health service. The noble Lord may not be aware that in the past few weeks in order to encourage good practice the NHS has distributed to its own hospitals the important policy documents developed by the hospice movement. I shall certainly make it my business to ensure that that good work is extended.

Lord Morris of Manchester: My Lords, speaking as a former Minister, I am naturally delighted that resources for the National Health Service will be so very substantially increased in the years ahead in further fulfilment of the manifesto promise. I congratulate my noble friend and, of course, my right honourable friend the Secretary of State for Health on what they have achieved. The figures mentioned in the Statement are huge. The NHS now has an opportunity to improve patient care as never before and, as my noble friend said, also to improve prevention. In proportion as we maximise prevention, the NHS will have still more resources to enhance patient care.

But is there anywhere in the Government's plans any provision for the modest cost of giving help that many of us in both Houses of Parliament seek for people who

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were infected with Hepatitis C by contaminated NHS blood products, and for the dependants of those who have now died of liver failure in consequence? My noble friend will be aware that we recently debated in your Lordships' House the depth of suffering caused by this tragedy in the haemophilia community. Is theirs not a compelling claim, more especially in view of the High Court's recent decision in favour of those who fear they may develop CJD due to NHS treatment? They fear a life-threatening condition. The patients infected by contaminated blood products with Hepatitis C now have a life-threatening condition. Does not that alone make their urgent claim for help a most compelling one?

Baroness Jay of Paddington: My Lords, my noble friend Lord Morris of Manchester, as always, shows his concern for those with a particularly unfortunate form of disability. I am grateful to him for what he said about the public health agenda. We hope that through that agenda we shall be able to prevent the 15,000 premature deaths a year of people who unfortunately die before their natural life span is ended through diseases such as cancer and coronary heart disease. As regards the specific point about those infected with Hepatitis C, I hope that my noble friend will be glad to learn that yesterday I met a cross-party delegation of 10 Members of another place and we discussed this issue thoroughly. I am now in the process of discussing that again with my right honourable friend the Secretary of State.

Lord Hunt of Kings Heath: My Lords, in welcoming the Statement, I observe that my successor as chief executive of the NHS Confederation has described the settlement as beyond his wildest dreams. In the 15 years that I occupied that post I was never able to make such a statement. Does my noble friend agree that in accepting this additional resource for the NHS, the NHS will be judged principally on whether it is able to modernise its services and facilities? In order to do that, three conditions must be met. First, the managerial infrastructure of the NHS must be developed, leaving aside the traditional debate of whether or not we have too many managers. Without question we have dedicated people who are underskilled and underdeveloped. They need to be developed much more fully to take on the leadership role that they have to accept.

The second condition relates to an issue that has been faced time and time again; namely, the public's resistance to changes in the use of many of our hospitals. Does my noble friend agree that until the medical profession in particular is prepared to lead that change and to explain to the public that that change is in the public's interest, proposals for the modernisation and reorganisation of our hospital services will continue to hit the buffers?

Does my noble friend agree that the third condition that has to be met concerns the way in which we deal with the staff of the National Health Service? Year after year they have accepted more and more pressure and have treated more and more patients. However, our human resource capacity is incredibly underdeveloped. We do not support our staff on the front line who are in

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"pressure-cooker" situations. Does my noble friend accept that we must improve our human resource management and the support that we give to staff?

Baroness Jay of Paddington: My Lords, I am tempted merely to reply "yes". My noble friend has, as always, made substantial points, with all of which I agree. To reflect on them in slightly more detail, I hope he will agree that the £5 billion fund for modernising the health service has been earmarked for precisely the kind of developments that we hope will assist managers, such as the IT revolution, and will be supportive of their activities.

I think it is fair to say, and it is a point that we want to make explicit, that there should be a clear attraction for people to do the jobs very well. That is one of the reasons why my right honourable friend the Prime Minister, in his speech to the 50th anniversary conference 10 days ago, referred to the concept of "beacon" hospitals; namely, hospitals that would attract more resources given that they were in a sense performing above expectations, and which would then, we hope, act as leaders within the profession of NHS management and within the medical and clinical professions in achieving the targets that we want to see developed.

Turning to the question of leadership of the medical profession in general, one of the most encouraging features of the past few months has been the ready acceptance, particularly by members of the medical and nursing professions, of the need to address issues of quality within the health service; and also, interestingly, the need to address the concept of a change of practice. It is true that leaders of professions may not always reflect the wishes and aims of other members of those professions who operate on the front line.

One of the most encouraging factors in trying to implement change and introduce documents such as A First Class Service, as we did a few weeks ago--which tried to demonstrate the need to introduce systems such as clinical governance, systems where professional performance is monitored, or where national guidelines are issued to the clinical professions--was the warmth of reception for those proposals. It has been most encouraging, and I am optimistic about that attitude.

On the question of staff, it is the case that human resources policy for the 1 million dedicated and committed members of staff who keep the health service going has been extraordinarily lax. My honourable friend Mr. Alan Milburn, the Minister of State in another place, is presently setting as one of his highest priorities in working with the new director for human resources for the health service the development of a proper, strategic human resources policy, which will include the recruitment and training of up to 7,000 more doctors and 15,000 more nurses, and will make it possible for us to take on a more strategic approach to precisely the developments that we need in professional organisation. The same approach needs to be taken to the very important matters, particularly in the nursing

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profession, of family friendly policies, and more flexible employment policies, which we hope will help with recruitment and retention of staff.

Lord Rea: My Lords, I join in congratulating my noble friend and her right honourable friends on producing the Statement. It is very welcome to those who are working, or have worked, in the National Health Service. However, the amount is not excessive; it is not prodigal. The amount is to be £3 billion per annum, year on year, over the next three years. It is a useful amount, and will allow the plans that the Government are developing, together with work of all kinds in the health service, to be put into effect.

Perhaps I may return to the burning question of nurse recruitment, and achieving the targets mentioned by my noble friend in increasing the numbers of nurses and doctors. From reading between the lines, I understand that the Government are, as it were, giving a nod and a wink to the review bodies that they may need to do something about helping to increase recruitment through decent salary awards. For instance, what is my noble friend's view of the statement made on radio earlier today by Christine Hancock of the Royal College of Nursing? She said that in recruiting and retaining nurses the question of the payment of staff must be a major consideration.

My noble friend Lord Bruce of Donington said that, as our health improves--in which we all hope and feel that this package will help--people will make less use of the National Health Service and that will save money for the health service. I think that that is a fallacy. If people do not die, they go on living--and they suffer from chronic diseases which cost the health service a lot of money. A recent paper from Holland indicated that mental health conditions, arthritis and locomotor conditions cost the health service more than conditions which kill.

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