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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

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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

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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

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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.

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