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Lord Hunt of Kings Heath: My Lords, my noble friend is absolutely right. The NHS was a great service and a wonderful vision for which many people in this country are extremely grateful. It has a great ethos and receives tremendous support from its staff and from the public. But, as the Kennedy report into the Bristol Royal Infirmary showed, it was starved of resources and capacity over many years. We are putting that situation right. The NHS Plan is the way forward, and I am confident that the NHS, in partnership with the voluntary, and indeed the private, sectors, will produce the high-quality services that we all want to see.

The Earl of Onslow: My Lords, how does the noble Lord justify the term "starved of resources" when the National Health Service has received an increase of 43 per cent in real terms over the past 10 years—half under one government and half under another?

Lord Hunt of Kings Heath: My Lords, so far as concerns the amount of resources going into the National Health Service, perhaps I may set out what is intended for the next five years. By 2008, NHS resources and healthcare spending in general will be brought to a level of 9.4 per cent of GDP. That is how we shall deliver the targets and priorities in the NHS Plan.

So far as concerns the previous government's record on expenditure, the fact is that they did starve the NHS of resources. When they increased the amount of resources—I refer, in particular, to the early 1990s—that went not on patient care but on the incredibly wasteful bureaucratic system of the internal market.

Lord Ashley of Stoke: My Lords, is my noble friend aware that not only would it be illogical to try to improve the health service by transferring funds from the health service to the private sector; it would also be highly undesirable? The stand outlined by my noble friend will receive warm support throughout the country, especially from the many millions of people who depend on the health service.

Lord Hunt of Kings Heath: My Lords, my noble friend is right that we must focus on improving and developing the National Health Service. But the issue that we face at present is a lack of capacity. That is why we are embarking on a major hospital building programme. It is also why we are increasing the

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number of training places and recruiting staff at home and abroad. However, with current capacity being very tight, it surely also makes sense to use the private sector, which at present has considerable spare capacity.

Baroness Howe of Idlicote: My Lords, the delivery target for digital hearing aids appears to have fallen behind substantially. Does the Minister agree that it would be useful to go into partnership in respect of digital hearing aids, not least in the fitting of the aids, in which the private sector has considerable expertise?

Lord Hunt of Kings Heath: My Lords, I certainly agree that the National Health Service should look for partnerships with the private sector where that sector can provide expertise that is not available within the NHS, whether in relation to services for deaf people or other services. That is the intention of the Government. I believe that over the past few years many schemes have shown the benefit of using private sector expertise.

Lord Phillips of Sudbury: My Lords, does the Minister agree that, given that the private healthcare sector has three distinct components—the profit-making one, the mutual one and the charitable one—the most natural partner for the NHS would be, first, the charitable sector, secondly, the mutual sector and, only thirdly, the profit-making sector?

Lord Hunt of Kings Heath: My Lords, I certainly welcome the long tradition of the NHS working with both the charitable sector and what the noble Lord describes as the "mutual" sector. I should have thought that the hospice movement is an example of that. But, ultimately, what counts is whether we can increase capacity in the NHS. Even with profitable private hospital care providers, if they have spare capacity which the NHS could use, we should use it.

Asylum Seekers

3.15 p.m.

Lord Astor of Hever asked Her Majesty's Government:

    Whether the health needs of asylum seekers who have entered the United Kingdom are being met.

Lord Hunt of Kings Heath: My Lords, people who seek asylum in the United Kingdom are fully entitled to NHS treatment without charge. In England, initiatives such as local development schemes, personal medical pilots and pilot health assessments for newly arrived asylum seekers are geared to meeting their health needs.

Lord Astor of Hever: My Lords, I am grateful to the Minister for that reply. What action are the Government taking to combat the worrying increase

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in TB among asylum seekers entering this country? In the borough of Newham, 200 out of every 100,000 people now have TB—a higher incidence than in India.

Lord Hunt of Kings Heath: My Lords, the noble Lord is right to draw attention to the problem of TB. The majority of asylum seekers entering the UK via east Kent ports are screened for, and, if appropriate, vaccinated against, TB as part of a Home Office-funded pilot. We shall review the results of that pilot in the new year and, in the light of that, make decisions about the future of screening newly arrived asylum seekers not only in Kent but throughout the United Kingdom.

Lord Greaves: My Lords, asylum seekers access the free health service via form HC2, which they use to apply for help with health costs. Such help, along with their housing and subsistence money, comes via NASS, the National Asylum Support Service. Will the Minister consider the case of those who reach the end of the process in terms of their applications and appeals and who are unsuccessful but who cannot be, and are not, removed from this country because they come from places such as Iraq to which it is currently impossible to send people? Such people lose not only their housing and subsistence payments but also their HC2 help with health costs. How are they supposed to access health services when they need prescriptions, dental treatment, sight tests, or whatever?

Lord Hunt of Kings Heath: My Lords, my understanding is that when applications are refused by the Home Office, asylum seekers often appeal against the decision. While appeals are outstanding, free NHS treatment continues. That is also the case in relation to those whose applications fail but who are given indefinite leave to remain in the UK. As the noble Lord suggested, that is appropriate where it is currently not safe for an asylum seeker to return to his country of origin. Those who do not appeal and who are not given leave to remain may be removed from the UK. While they are waiting for that to happen, they will not be refused any treatment they require before removal.

Earl Ferrers: My Lords, did I hear the Minister aright? Did he say that when asylum seekers arrive in this country and are found to have tuberculosis, they are given a jab and then sent on their way? Is that sensible? Does it not encourage spread of the disease?

Lord Hunt of Kings Heath: My Lords, clearly we need to ensure that health-screening measures are appropriate. I referred to a pilot scheme being undertaken in east Kent. We shall consider the evaluation of that pilot to see how well it works. We are concerned about TB and its potential spread. We are keeping the matter under tight review.

Lord Avebury: My Lords, does the Minister agree that proper records should be maintained of asylum seekers who are pregnant or who have suffered recent

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miscarriages? In which places of detention does he consider that adequate healthcare facilities are available to such persons?

Lord Hunt of Kings Heath: My Lords, there is a problem with health records, particularly as asylum seekers move around the country. There is no doubt that hand-held patient records are the most appropriate method for dealing with the problem referred to by the noble Lord and for recording health information. The asylum seeker would keep the hand-held record and take it to health appointments wherever that may be. Many areas have developed their own hand-held records for issue to asylum seekers. My department is working with front-line staff on the development of a national model.

Lord Roberts of Conwy: My Lords, can the Minister tell the House how the additional costs to the health service of asylum seekers are met? He will be aware that there are signs of stress in the NHS.

Lord Hunt of Kings Heath: My Lords, such costs fall within the NHS budget. We are dealing with that in a number of ways. We are looking to make the funding formula sensitive enough to ensure that primary care trusts receive an appropriate allocation. We have also pursued a number of local initiatives, such as local development schemes, where additional money is allocated by the department to help primary care trusts and GPs in specific areas. The flexibility of the personal medical service pilots in relation to the remuneration of GPs may also be of assistance. I acknowledge that particular areas of the health service are under financial pressure as a result of this situation.

The Earl of Sandwich: My Lords, can the Minister confirm that the full range of health services will be available to asylum seekers in the new accommodation centres and that there will be no discrimination, as there is in education?


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