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Baroness Greengross: My Lords, I am sorry, I want to ask two questions. I welcome the fact that nursing care--looking after old people--will now be free at the point of delivery, wherever the person is. But could not that be defined sufficiently broadly to encompass care which needs to be given or supervised by a fully qualified nurse? As the numbers of old people increase, there will have to be some instances of delegation to people who are not fully state registered. We do not fall into little boxes, particularly as we age. Many people suffering from multiple pathologies get weaker and stronger as they are cared for during treatment and rehabilitation.
On the previous point, I fear that I am becoming repetitive. I can only repeat what I said to my noble friend Lord Ashley and the noble Lord, Lord Clement-Jones. Perhaps the noble Baroness will refer to paragraph 2.9 on page 11 of the report which states:
Baroness Jay of Paddington: My Lords, I do not believe that maternity services as such are contained in the national plan. I am afraid that I cannot tell the noble Baroness what private discussions were held with National Health Service staff. My suspicion is that if National Health Service staff had wanted to focus on those services and had wanted to advocate them with great vigour, they would have been contained in the plan. That is not to say that they did not advocate something that it is worth while looking at, but it was not something that emerged as a major national priority. That is probably because, on the whole, maternity services are rather good.
The next national service framework, as the noble Baroness may be aware, will be in relation to older people. The Government have not made a decision about the national service framework to be developed after that. It probably would be useful if other priorities were set out and perhaps in that context maternity services would be included.
I understand that one way of looking at the care trusts--this may be familiar to the noble Baroness with her great knowledge of the organisation of health and social care in the United Kingdom--relates to the way in which social care and health boards are organised; for example, in Northern Ireland there is an integrated provision of services and governance seems to be satisfactory.
Lord Bruce of Donington: My Lords, this afternoon is a very moving occasion for me. I sat in this House, which was then the House of Commons, while the entire National Health Service Bill was passed. I congratulate Her Majesty's Government on the way in which the plan and programme, which I have now read, have been put before the House. I also
Lord Jacobs: My Lords, I strongly welcome the Statement, particularly the significant increase in expenditure of more than a third over the next few years. However, I do not agree with the comments that National Health Service expenditure should have been greatly increased three years ago because, when the Government came into power, there was a deficit of £28 billion. Nevertheless, the Government have had three years to consider these proposals. Included in the proposals is an increase of 7,000 in the number of doctors. Will the Government and the noble Baroness consider what the public should be told about the fact that it will take between five and seven years to train 7,000 new doctors and, therefore, they must not expect quick results under these new plans?
Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord, Lord Jacobs. I believe that I said in the Statement that such matters must be related to the time for training and the time for improving the labour force, if one can describe it that way, of the health service in all professions and in all healthcare areas. We are building on a situation where already more doctors and nurses are in training and more doctors and nurses are being recruited into the health service than three years ago. The additional number that has been announced this afternoon is based on a position that is already strong.
Lord Glenarthur: My Lords, the noble Baroness referred in the Statement to 100 new hospital schemes over the next 10 years. Are they to be funded under the PFI initiative or centrally? In relation to her reference to run-down premises--I draw on my own experience as a chairman of an NHS trust in London for several years--can she tell the House whether the system of capital allocations will be changed to allow those that may have to last for 10 years or more to be suitably built, rebuilt, added to, or adapted in a way that meets the aspirations to which the Statement refers?
Baroness Jay of Paddington: My Lords, the expansion of buildings and facilities, to which the noble Lord rightly draws attention, will be achieved by a combination of the schemes that are exclusively PFI and other methods of funding. I am sure that the noble Lord will welcome the fact that within the plan, although not within the Statement, was the fact that this autumn £30 million will be given to hospitals to clean up wards and so on--in other words, to have a spring clean in October.
Perhaps I may make a specialised plea for one group of patients who are rather neglected, who are subject to the postcode lottery and who, in many cases, are subject to inordinate waiting lists and a great unevenness of practice. Given the Government's commitment to family values and the importance of the family, can my noble friend the Leader of the House give us some assurance that people with reproductive difficulties will be better catered for in the forthcoming health service?
Baroness Jay of Paddington: My Lords, I am grateful to my noble friend for his support for the plan overall. On his special pleading point for his own specialty, which we understand, I am sure that he realises that some of the arrangements that are being made for the commissioning of specialist services should iron out the problems that he has described to your Lordships' House relating to "postcode treatment" of people who have particular problems. That is something that could be addressed by a national service framework and, as in the case of maternity services mentioned by the noble Baroness, Lady Cumberlege, this could be a good candidate for future work in that area.
I am grateful to my noble friend for making the point that this must be a collaborative effort by everyone involved in healthcare. I recommend to the entire House the statement of principles at the beginning of the plan which sets out, in the most sensible and clear way, the basis on which the plan will be taken forward. As I said originally in answer to another question, it is signed by all those who have a particular responsibility for delivering healthcare, not only on a non-political basis, but also on a professional and a patient-centred basis. We all hope to achieve that.
The noble Lord said: My Lords, the first four items in the report were first put to the House in the committee's last report which was debated on 21st June. At the end of the debate I withdrew the Motion to approve the report, partly in response to complaints that the report did not contain enough information. At its most recent meeting, the committee reaffirmed its approval of these items, which are now reported back to your Lordships but in greater detail. The final four items in the report
As I believe the House will expect, I now turn to item 5, the proposal to appoint a consultant to lead a review of the management structure of the House and the structure for taking decisions about its services. After this proposal was criticised during the debate on 21st June, both the Finance and Staff Sub-Committee and the Offices Committee reconsidered the matter at great length. For the reasons set out in the report, the committee remains convinced that a review is necessary. But as your Lordships will have seen from the report, the terms of the proposal have been revised and, in addition, we recommend that it should take place under the supervision of a small steering group of Peers.
The financial management structures of the House have not been reviewed since they were put into place in the early 1990s when the two Houses assumed control of all parliamentary expenditure. In the last financial year, the budget for this House alone was £45 million. A review would help to assure the House that its services are being delivered efficiently and that its procurement procedures are robust enough to avoid the threat of litigation.
As the report notes, the House of Commons may change the way in which it supervises the services which are shared between the two Houses, such as the Parliamentary Works Directorate. It seems sensible for this House to take any changes into account and to respond to them if necessary.
I should also like to say a word on behalf of the Clerk of the Parliaments, who has been charged with the responsibility for delivering services for the House. He would welcome advice on these matters and, if for no other reason, Members may wish to permit him to seek the advice that he requires in order to discharge his responsibilities to the House. That is not intended to imply that the House is badly managed at present. However, although it is clearly the case that we have great expertise within the House, I would hope that we would not regard ourselves as the sole repository of all wisdom and knowledge on these matters or that we are not capable of benefiting from outside advice. A review would benefit from the involvement of someone with knowledge of modern management practices and who could approach the task without any preconceived views. That is why the committee recommends the appointment of Mr Braithwaite to conduct the review.
As the report emphasises, the final decision on whether or not to implement any recommendations will be made by the House and its committees. But I appreciate the desire within the House to keep any review under its control, especially after the criticism of this proposal last time. The committee therefore proposes that a small steering group of Members of the House be appointed to supervise the review. I do not believe that the House has anything to fear from what is proposed, since decisions remain within the control of the House. On the contrary, I believe that
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