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Baroness Carnegy of Lour: My Lords, perhaps I may put one or two rather detailed points to the noble Baroness. Like my noble friend, I very much welcome the infusion of money. I take it that the £2 billion includes Scotland and Wales. First, does the £2 billion include the big increases in wages and salaries that have already been awarded recently? Does it also include the outcome of the review of long-term care which is under way? If that is the case, it indicates that the whole sum will not be available for the reforms with which the Statement is concerned.
On the question of Scotland and Wales, the noble Baroness mentioned the First Minister of the Scottish Parliament and the First Secretary in Wales as taking part in the group that will make the final decisions. Do the five challenges set out in the Statement that are being put to the health service by the Prime Minister apply to health authorities in Scotland and Wales as well? Will the four-year plan that is to be agreed apply to Scotland and Wales? If so, when will the Scots Parliament have a say in this matter? The health service is a devolved matter for Scotland, as it is for Wales.
Baroness Jay of Paddington: My Lords, the noble Baroness's final point is entirely relevant. Health matters are devolved to Scotland and to Wales. I think what my right honourable friend was indicating in referring to the consultations that he intended to have with the First Minister and the First Secretary in Wales, was that the National Health Service is a UK institution. Of course, the funding is somewhat different. The arrangements even for administration and management within Scotland and Wales are slightly different. However, the aspirations for achieving the challenges and for meeting the targets set out are ones which I am sure both he and the Secretary of State for Health in England and Wales would regard as particularly important for the whole of the unified system.
It is important that we have a more consensual approach to reaching the targets, as I hope the Statement made clear. The reference was made in the context of bringing in the professions, presumably from different parts of the United Kingdom, as well as those responsible for administration. Clearly, although the overall settlement is UK-wide, there will be differences in the way in which resources are deployed. In Scotland, those will be matters for the Scottish Parliament, as the noble Baroness rightly said.
Wages and salaries fall to be met out of the overall budgets, but the figures given are for real terms growth. As the noble Baroness will know, they are susceptible to the outcomes of the independent wages and salaries review boards which are referred to the Government for the year in question. The real terms
Is my noble friend aware that, judging from what I saw this morning in my own hospital trust, which I believe is representative, the Budget announcement has led to a real enthusiasm which I have not seen for a long time in the health service. It will clearly do a huge amount for morale. In particular, it will do a great deal for those hospitals in inner-city areas in deprived parts of the country.
My noble friend the Lord Privy Seal mentioned bench-marking. She, above all, is well aware that one of the problems in relation to disease is that its quality and severity, and indeed the stage of any disease, often depend on a whole range of factors, such as poverty, education and environment. One of the problems with performance indicators and bench-marking is that it is difficult to compare trust with trust across different parts of the country. I know that the Government are aware of that and that they have it fully in mind. A simple league table is clearly not the answer.
One of the problems in the health service is that, as a result of a very long period of neglect, the fabric has been run down. Consequently, one major investment that has been lacking is in information technology. Information technology would do a great deal to provide useful comparators in the health service which could lead to a better assessment of performance. Perhaps my noble friend will comment briefly on whether part of the extra money might be spent on examining how we can best gather information within the health service.
Baroness Jay of Paddington: My Lords, I am very grateful for my noble friend's reaction and for his comments about the enthusiasm that he finds in his trust. Having known my noble friend very well over many years, I know that he speaks from a completely independent and objective assessment and reports accurately his experience in his own trust. I simply tell the House that it is reflected in a conversation in which I was involved this morning in Ipswich, in a non-inner city area, where a Conservative county councillor, who is also the chairman of the local health authority, was equally enthusiastic about the infusion of extra funds. As the Prime Minister and the Chancellor of the Exchequer have said, I hope that this will be seen as a nationwide enthusiasm. I certainly hope, to echo my noble friend's remarks, that it will raise morale and performance right across the health service.
My noble friend is, of course, absolutely right about the complexities of simple target setting within the NHS. He mentioned the social issues of poverty, education, and the environment which tend to affect the severity of disease and the problems which bring people to hospitals and to see their GPs at different stages of disease. I am sure that he will be aware that a great deal of work is being done in the Department of Health both to look at those complicated issues in the statistical sense, and, more importantly, to address the broader issues of ill health, so that there will be a better prevention programme as well as a public health programme which will back up the health service issues.
The question of IT is, of course, a priority for NHS expenditure. I know that there is a major commitment in the health service and in the Department of Health to taking forward the IT strategy which was developed two years ago. This will ensure that the exchange of information necessary to assist in the management of disease, and the practical advantages to patients of booked appointments, is spread as widely and as quickly as possible.
Lord Clement-Jones: My Lords, I too welcome the additional funds announced yesterday and today. I believe that they have the potential to make a real difference to the NHS in the years to come. Perhaps I may ask the Leader of the House two questions. First, the Prime Minister in his Statement highlighted a consultation process with people responsible for healthcare in every part of the country. Will this be about how the additional funding is to be spent in this year, as well as in the following years? If so, the Secretary of State's speech today seems to conflict with that. He referred to allocations being made, and specifically one of £650 million, and he seems already to have decided what the expenditure should be. There appears to be a lack of clarity in that respect. Perhaps I may ask whether this consultation exercise will be a genuine bottom-up process or a top-down process, which seems to have characterised quite a great deal of the Government's expenditure to date. I am sure that we all want to see the four-year action plan, to which the Prime Minister referred, genuinely owned by those who work in the NHS. But if there is no adequate consultation, it will not be.
Secondly, perhaps I may follow up the question asked by my noble friend Lord Rodgers about the status of the Comprehensive Spending Review, about which there appears to be a lack of clarity. Has the Department of Health's total budget for this and the following four years now been set? If so, can the Minister, the noble Lord, Lord Hunt of Kings Heath, indicate very soon the decisions that will be made on the Children (Leaving Care) Bill rather than waiting until the Comprehensive Spending Review?
With regard to the broader point, as I hope that I made clear to the noble Lord, Lord Rodgers, the four-year spending agreement is not, as the noble Lord, Lord Clement-Jones said, related to the Department of Health's spending. It is related to NHS spending. However, that is the agreed programme.
With regard to the question of the consultation process, my understanding is that the allocation of the £600-odd million referred to in the Secretary of State's additional Statement this afternoon relates to the extra £2 billion which will be made available at the beginning of this immediate financial year. The consultation process on the new national strategy, if that is what we wish to call it, which is to take place over the next few months, will be about putting the plans for the health service in a broader, longer-term context. As I said in reply to the two noble Lords who spoke from the Front Benches, the hope is that this agreed spending over the four-year period will enable proper planning and understanding of agreed targets to be the subject of consultation over that longer period of time.
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