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Health

Volume 404: debated on Tuesday 29 April 2003

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The Secretary of State was asked—

Nhs Staff (Resources And Decision Making)

1.

What plans he has to devolve resources and decision making to front-line staff. [109800]

Power and resources are being devolved to the NHS front line. The old health authorities and regional offices have gone, and new primary care trusts are now in place, which control three quarters of the total NHS budget so that local services can be shaped better to meet the needs of local communities.

Does my right hon. Friend accept that to create a world-class health service we need both investment and reform? Investment is running at record levels. Is it not now time to try to influence, involve and empower all members of the NHS team in taking forward our health service?

I very much agree with my hon. Friend. Clearly, record resources are now going into the national health service, and we have the fastest-growing health service of any major country in Europe, after many decades, including under the previous Government, during which investment was cut back rather than increased. As my hon. Friend rightly says, we need reforms in the system as well as resources, and now is not the time to take our foot off the accelerator of reform. With the extra resources going in, we need to see as much pace on reform. In particular, we need to ensure that we get the balance right in relation to standards being set nationally to guarantee equity in the system, about which we have done a lot over recent years, with national standards and national systems of inspection. Ultimately, however, neither I nor this place delivers health care: it is delivered out there in local communities by local members of staff. Those people, both in the community and among members of staff, should be empowered.

But does the Secretary of State acknowledge that, two weeks ago, Dr. Ian Bogle of the British Medical Association said that new evidence showed that 80 per cent. of doctors had not seen any improvement as a result of the increased NHS spending, and that excessive national targets were preventing additional money from reaching the front line of health care? Does he agree that it is not surprising that the general public have lost confidence that the Labour Government are capable of delivering a first-class NHS?

Of course, Dr. Bogle is a member of the NHS modernisation board, which produced its recent annual report. I do not know whether the hon. Lady has had an opportunity to look at that annual report, but among other things it said that the money was getting through to the front line. Indeed, it went on to say that the NHS was turning the corner. Clearly, there are problems that are still outstanding, but the only way of addressing them is to continue reforms in the national health service and continue putting resources into it, and not to do what the hon. Lady and her party propose, which is to cut NHS budgets by 20 per cent.

Is not my right hon. Friend the Secretary of State anxious that his proposals for foundation hospitals may reduce the improvements that primary care trusts are bringing in representing local communities and that "agenda for change" has the potential to bring in terms of NHS staff pay?

No, I am not anxious about that, for a number of reasons. First, for the very first time under the NHS foundation trust proposals—I think my hon. Friend has seen a copy of the Bill that has now been published—primary care trusts will be represented on the board of governors of NHS foundation trusts, thereby strengthening the link between primary and secondary care, which I know is what she is keen to see, as I am too. I think she is further aware that, in addition to the safeguards already in the Bill, I have given a guarantee that the "agenda for change" pay system, which we have negotiated with the NHS trade unions—to which I am pleased to say both the Royal College of Nursing and the Royal College of Midwives, have given the go-ahead in ballots by votes of 80 per cent. and 90 per cent.—will apply across every part of the national health service, including in NHS foundation trusts.

Does the Secretary of State agree that what most people want to see in terms of resources in the front line is a full range of complementary and alternative therapies? May I take this rare opportunity to congratulate him on his announcement over Easter of £1 million to go into research and development in relation to complementary therapies? Can he explain why that news came out over Easter, as the bank holiday weekend is traditionally used to put out bad news? Is it because he is acutely embarrassed that it has taken the Government so long to see the light, and the need for a greater use of complementary and alternative therapies in the health service?

I know that the hon. Gentleman has a certain regard for complementary therapies. I do not think that they are the talk of the pubs and the clubs in my constituency, but they may well be in his. One of the reasons why we gave the go-ahead for the additional £1 million was in the very real hope that he would not raise this issue at every single Question Time. Alas, my hopes have been dashed.

The NHS is refusing to spend £30,000 for a bone marrow transplant programme for my constituent, Diana Fildes, who has Crohn's disease. Will the devolving of resources start to help people such as Diana in the future? Is it not a mammoth task for family, friends and former pupils to have to seek to raise £30,000 in funding for private treatment? What have we got a health service for if not for that?

I am not aware of the case that my hon. Friend has raised but, if he passes me details, I will be more than happy to look into it and to come back to him.

In making the changes in the NHS, it is important that we get the balance right. It is obviously important—I think that most people would agree on this—that we should have national standards and some national targets in place precisely to ensure that there is equity in the system. None of us—at least on the Labour Benches—wants to go back to the days when, for example, cancer drugs were available in one part of the country but not in another. Equally, having put those national standards and national systems of inspection in place, it must be right that we give both the people who are responsible for delivering the care and the communities that receive it a greater say in how those services are provided to local communities. That is what primary care trusts are about arid it is what NHS foundation trusts in time will be about, too.

Worcestershire Royal Hospital

2.

What assessment he has made of the performance of the Worcestershire Royal hospital. [109801]

The Worcestershire Royal hospital, as part of the Worcestershire Acute Hospitals NHS trust, was awarded two stars in the latest NHS performance ratings, received a positive Commission for Health Improvement clinical governance report recently, and achieved all its waiting list targets for the end of March 2003. I would like to congratulate all the staff at the hospital on their commitment and dedication to the needs of NHS patients.

I thank my right hon. Friend for that reply. He may have noticed that the Worcestershire Royal hospital was shortlisted as one of the top six hospitals in the country by a recent survey in The Sunday Times. Would he add his congratulations on that achievement and does he share my dismay that one Member of the House commented that The Sunday Times survey must be worthless because the Worcestershire Royal hospital did well in it? Does he agree that such comments do nothing for staff morale and nothing for the recruitment of key medical personnel, but have everything to do with undermining faith in our national health service?

The Worcestershire Royal is an excellent hospital that is doing a very good job in improving the range of services available for local people. I would certainly like to emphasise the achievements that have been made in the hospital. I also think it is incumbent on all right hon. and hon. Members to support their local NHS. When that does not happen, it is a cause of great disappointment, not least to staff locally.

Notwithstanding the very real achievements that doctors and nurses have made at the hospital, I am sure that the Minister would wish to say that there are some very real problems at the trust. The district auditor's report identified it as the most expensive in the west midlands, and there are acute car-parking problems and patients cannot make appointments. [HON. MEMBERS: "Oh, dear."] I am sorry that Labour Members feel that patients not being able to make appointments is a matter of no concern. There are also serious waits on trolleys after accidents, and a whole range of problems. Will the Minister tell the House by when the trust will have to clear its accumulated deficit, because the great pressure it is under to meet financial deadlines imposed by the Government is inhibiting its ability to deal with its remaining problems? When will it have to clear its deficit?

I think the hon. Gentleman is right to draw attention to the fact that there are continuing issues. He has referred to the problems of car parking at the hospital, which I understand the local trust is addressing.

In relation to resources, I caution the hon. Gentleman, who I know is a strong supporter of the NHS. It is important to bear in mind that, over the next three years in Worcestershire, the NHS will see a growth in resources of more than 30 per cent., and that is very important. It will help the trust to address those underlying difficulties and it will allow the service to grow and expand to meet the needs of local people. I simply say to the hon. Gentleman in the politest way that I can that it is no good coming to this place moaning about the financial position of local NHS trusts when he and his party will not support the additional investment that is going into the NHS.

The Minister will be aware that the wait for an MRI scan in Worcester is more than 12 months and that the mobile MRI scanner at Kidderminster, where the waits are shorter, is about to be withdrawn. Will he ensure that the static MRI scanners to be installed elsewhere in the county— particularly in the diagnostic and treatment centre at Kidderminster—are not delayed by the county's financial deficit?

I am not familiar with that particular problem, but I will certainly look into it.

Dual Diagnosis

3.

If he will make a statement on services provided to patients with dual diagnosis of mental health and addiction problems. [109802]

As part of the work to modernise mental health services, the "Dual Diagnosis Good Practice Guide" was issued last year. Following the publication of the national service framework for mental health, we have embarked on a radical modernisation of services to improve access to effective treatment and care, to reduce unfair variation, to raise standards and to provide quicker and more convenient services to all people with mental health problems including those with a dual diagnosis of addiction.

Does the Minister agree that such patients have a particular need for supported accommodation and ongoing social services support? However, because they have the greatest problems, they are often the ones who fall through the safety net. Will she consider increasing resources for programmes such as assertive outreach and ensuring that patients with dual diagnosis problems are taken into account?

My hon. Friend raises an important point. Despite the considerable extra investment in our mental health services and staffing increases, we nevertheless need to examine new ways in which to organise the services. I strongly agree with her, as we spelt out in the national service framework, that assertive outreach teams are particularly able to get to some of the people who have fallen out of touch with services in the past, perhaps because they had additional problems such as drug or alcohol addiction, which had knock-on bad effects for their health and for communities as a whole. That is why I am pleased that extra investment for assertive outreach teams is being considered in Tower Hamlets. The existing investment in our mental health system means that 191 additional assertive outreach teams are operating throughout the country to bring people who had lost touch with mental health services back in touch.

A lesson from the first Gulf conflict was that many returning service personnel were susceptible to mental health problems, which were often combined with addiction problems, especially alcohol addiction. Given that fewer than 20 per cent. of the Government's required crisis resolution teams are in place, how can the Minister justify her claim on 6 March that there is

"operational flexibility within the system"
to enable the NHS to deal with the mental health needs of servicemen and women returning from the Gulf, many of whom are likely to be given a dual diagnosis? Is it not the truth that the Department of Health and the Ministry of Defence are woefully unprepared?

No, it is not. As I have spelt out in response to the hon. Gentleman's questions, it is clearly the business of mental health services to deal with any mental health problems that might arise when people return from active service, as is the case with the wide variety of other needs that they address. We have made it clear that people with a dual diagnosis of mental health problems and drug or alcohol addiction are mainstream business for mental health services.

The hon. Gentleman seemed to suggest that we need more investment and an expansion of capacity. As I have said, there are already 191 extra assertive outreach teams. We have 62 more crisis resolution teams, 22 more early intervention teams and there are 25 per cent. more community psychiatric nurses working in the system than in 1997. There are problems and the only way in which to address them is to continue with the investment that the hon. Gentleman and his colleagues have opposed far too often.

Fewer than 3 per cent. of people with an addiction to heroin are receiving medical treatment. How long will we allow a presumption in favour of dual diagnosis to be a smokescreen for stopping proper medical treatment for such people?

The dual diagnosis guidance that we issued made it clear that treatment for the significant number of people who have both a serious mental illness and a drug addiction is part of the mainstream business of mental health services. We need to do work, especially to ensure that we reduce waiting times for people who need specialist treatment services, which also have specialist mental health services alongside. We are making progress on extra capacity and new ways in which to deliver those services. I agree with my hon. Friend that it is unacceptable if people do not receive suitable treatment. We will ensure that we address the problems through the additional investment and new forms of treatment that we are implementing. However, only the investment that we are undertaking will ensure that that happens.

Needlestick Injuries

4.

If he will make a statement on needlestick injuries. [109803]

The Government recognise that the number of needlestick injuries occurring in the NHS is still too high. The Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), recently met the all-party parliamentary group on occupational safety and health and agreed that new guidance will be issued to the service in the autumn.

Given that the annual cost of treating NHS workers who have suffered needlestick injuries is estimated to be in the order of £300 million and that the estimated saving from acquiring safer needles could be about £140 million, and given that even when needlestick injuries are subsequently shown not to have caused serious physical harm they almost always cause immense emotional trauma, will my hon. Friend join me in supporting the objectives of the Needle Stick Injury Bill promoted by my hon. Friend the Member for Crawley (Laura Moffatt)?

My hon. Friend is right that needlestick injuries are a serious issue in the NHS. They cause immense distress to staff, especially when they are waiting for the test results to discover whether they have been infected. That is why we support the work of the safer needles network and why the Department works with trade unions and staff on that issue. Safer devices have a role to play. Equally important, however, is excellent training for staff on how to use those devices, and refresher training has been proven to reduce the number of incidents dramatically. On the Bill, health and safety legislation requires incidents to be reported. We want those regulations to be used as much as possible to ensure that we have the fullest possible information so that we can support staff in those difficult conditions.

Nhs Dentistry (South Devon)

5.

If he will review the level of provision of NHS dentistry in South Devon. [109804]

We are committed to rebuilding and restoring NHS dentistry to continue to improve the oral health of the nation. Alongside the proposals in the Health and Social Care (Community Health and Standards) Bill, 26 field sites covering 50 different locations are being set up to test different ways of providing NHS dentistry. One of the largest of these field sites covers the south-west peninsula and builds on the successful personal dental services pilot in Cornwall.

In spite of that answer, is the Minister aware that no dentist in Totnes is taking newly registered patients and that it takes a whole day on public transport to go to and to be treated by an NHS dentist, which is not possible for many people? Would it help if we ring-fenced the dentistry part of the primary care trust budget to relocate dentists into south Devon?

I know that there are problems of access in south Devon because of rurality. If one dentist leaves a town or village, it can mean that people cannot get registered. That is why we are putting in dental support teams across the country where there are still access problems and the hon. Gentleman's area will of course be considered for that. I hope that he will support the Bill that I mentioned to ensure that primary care trusts can commission dental services in the way that he suggests.

Care Workers (Kent)

6.

What plans he has to increase the number of care workers being trained in Kent. [109805]

Training of care workers supports and protects vulnerable people and helps to recruit and retain important staff. That is why we are providing more than £2 million of additional money to councils in Kent this year specifically for training and work-force development, as well as funding through Topss England, formerly the National Training Organisation for Social Care, to help the staff of all social care employers in Kent to undertake training and qualifications.

I welcome that extra investment for Kent. I know that my hon. Friend takes a close interest in all Kentish matters and she is welcome in the garden of England any time.

In addition to that investment, £750,000 has been secured from the Learning and Skills Council by the Kent community care association, working in partnership with Unison and local authorities to train some 40,000 care staff throughout the county. Is it not the case that quality training is crucial to recruitment and retention of care staff? What is my hon. Friend doing to monitor and evaluate the situation? It is all very well getting the cash, but it is essential that it is used to good effect for the benefit of older people throughout the county.

My hon. Friend is right. I enjoyed our meeting with the Kent community care association, which, as an employer in the voluntary, independent arid private sector, has clearly showed its commitment to training staff. However, it has also recognised that in the past it has sometimes been difficult, even when additional resources have gone to local authorities, for a significant number of employers in the independent sector to get access to those funds. That is why we will be putting a condition on the additional money that we will make available over the next three years requiring 50 per cent. of it to be spent in the independent sector.

My hon. Friend rightly said that that will clearly make a difference to the number of people being trained, which is why the national minimum standards, particularly in domiciliary care and care homes for older people, now include requirements that people who are caring for the most vulnerable people in our communities receive the necessary training. That will be monitored by the National Care Standards Commission and will play an important role in improving the status of people who work in care, thus helping us to recruit into that work.

Does the Minister accept that one of the problems facing trainees and care workers in Kent and elsewhere is the fiasco over the past 12 months with the Criminal Records Bureau? Does she accept that notwithstanding the two U-turns that the Government have had to make there are still considerable problems? Does she not feel that it was unwise not to accept the advice of the Opposition prior to the implementation of checks, to the effect that the bureau was over-ambitious in seeking to check everyone from the outset? What is happening to the backlog, as opposed to current applicants requiring a check? The evidence suggests that there is a considerable problem with that backlog despite the fact that current applicants are being dealt with quicker.

I think that the hon. Gentleman arid I will have a chance to pursue that at greater length later this afternoon, but I can offer him reassurance now. I share his concern about the performance of the Criminal Records Bureau, which is why my right hon. Friend the Home Secretary instituted a significant review of its operations and why we, along with other colleagues in government announced last November a delay in implementing some of the bureau's checks for certain groups of workers. We wanted to make sure that we could get the bureau back into the shape necessary to provide protection for vulnerable people—a role in which I believe it plays an important part.

I can assure the hon. Gentleman not only that there are now substantially more checks every week than last summer but that significant inroads are being made into the older applications that had got stuck in the system. My understanding is that the vast majority of those have now been worked through. Not only has the old problem been solved but the bureau is now operating far more efficiently. I am sure that the hon. Gentleman will join me in recognising the important contribution that that will make to safeguarding vulnerable people.

Finished Consultant Episodes

7.

If he will make a statement on the number of finished consultant episodes in the NHS in England in each of the last four years. [109806]

The number of finished consultant episodes in the national health service in England increased from 11.6 million in 1997–98 to 12.4 million in 2001–02. For 2002–03, hospital in-patient activity is expected to increase by a further 4.5 per cent, and outpatient activity by a further 2.5 per cent.

I thank the Minister for his answer, although I note that he did not give a figure for finished consultant episodes for the coming year. The Chancellor of the Exchequer and the Secretary of State have made it clear—[Interruption.] The Minister gave a figure for elective admissions, where there has been a 4.5 per cent. increase, but did not give a figure for finished consultant episodes. The Secretary of State and the Chancellor have made it clear that increased reform in the NHS must accompany increased spending, yet we have all seen in our constituency surgeries that spending does not appear to result in our constituents having fewer problems with the NHS. If anything, the situation is getting worse. Can the Minister tell us when he expects increased spending in the NHS to be matched by increased activity?

I am sorry, but the hon. Gentleman clearly does not understand what he is talking about. The figures that I quoted to him are for finished consultant episodes in the years for which the information is available. I cannot give a figure for the number of finished consultant episodes for this year, because this year has not ended yet. The information is historical, not prospective. The hon. Gentleman asked when the additional investment in the national health service would produce additional activity. It is already doing so. For example, it has helped us to recruit an extra 5,500 consultants for the NHS, almost 50,000 additional doctors and almost 8,500 additional allied health professional therapists. The NHS is busier than it has ever been before. If the hon. Gentleman wanted any confirmation of that, he would just need to ask his local NHS staff, who would tell him that the NHS has never been busier.

Is my right hon. Friend aware that the number of finished consultant episodes—that is, the number of patients treated—at York district hospital has increased over the past four years by 11 per cent., and that in some specialties—in general medicine, for instance—the number of finished consultant episodes has increased by 34 per cent.? Will my right hon. Friend congratulate the York health trust on its achievement? Does he agree that if the Conservative party were ever in a position to implement its cuts—

I join my hon. Friend in warmly congratulating the staff in York on the excellent job that they are doing. He, like me, would probably have concluded from these and earlier exchanges that there are some people who want to talk down the national health service, as a cloak for a broader attempt to undermine the NHS and replace it with private provision and top-up vouchers—something that the Labour Government will never do.

Given that we need more operations than we have at present to clear the backlog, can the Minister explain why the Government have decided to spend so much extra on administration, rather than on front-line care, so that there are now more administrators than beds? Is that not a strange choice?

That is a hackneyed and well-worn contribution, and is simply not true. The right hon. Gentleman reaches that conclusion only by counting cooks, cleaners and porters as managers and administrators. Anyone with common sense—I am afraid that that excludes the right hon. Gentleman—would know what a load of nonsense that equation was.

Gp Waiting Times

8.

If he will make a statement on progress towards the target of no patient's waiting over 48 hours for a GP appointment. [109807]

The most recent data from February this year show that nationally some 86 per cent. of patients are now able to be offered a GP appointment within two working days. In 1997 the comparable figure was only 51 per cent.

I declare a non-registrable interest, in that my wife is a GP.

Is the Minister aware that in West Berkshire there is one surgery that has had a vacancy for some months, which it is unable to fill? Locum GPs are like gold dust: they are so rare. Does the right hon. Gentleman accept that until the supply of GPs is improved, trying to meet the targets will make life intolerable for some GPs, particularly when one member of their practice is absent because of illness, holiday or a recent retirement?

I agree with the hon. Gentleman in one respect—that we need more GPs in the national health service, and we are recruiting more. Since 1997 there are 1,200 more GPs working in the NHS. That is a positive development, which I am sure he would welcome, as would his wife. There are local recruitment problems. That is obviously the case, as all right hon. and hon. Members know from their constituencies. I am advised that in the primary care trust in the area that the hon. Gentleman represents there are now 11 more GPs working than in 1997. That is progress, but I agree that there is more to do. I do not, however, agree that we will not meet the target unless there are significantly more GPs. The work of the primary care collaborative has shown—I do not know whether there are practices in the hon. Gentleman's primary care trust that have taken part in the work of the collaborative—that by looking critically at how we structure appointments in primary care, it is possible to provide patients with better access. One thing that I have learned, both as a Minister and as a Member of Parliament, is that access to the services of a GP and a hospital is the public's top priority. That is what we are trying to meet, and that is what the targets are designed to help bring about.

Does the Minister accept that one of the factors in obtaining an appointment with a GP is coping with rising population trends in areas such as Swadlincote in my constituency? Will he therefore advise NHS management to ensure that we proceed as rapidly as possible with the LIFT—local improvement finance trust—project to rebuild Swadlincote's clinic to accommodate a new GP practice, which would greatly improve access to GP care from that town?

Yes; I agree with what my hon. Friend says. The NHS LIFT programme is a very welcome boost to investment in primary care ensuring that almost £1 billion of investment will go into the infrastructure of the NHS primary care estate. That is long overdue, and it is an essential complement to the work that we are doing to improve services and secondary care. I agree strongly with what he said.

As ever, the Minister's response tells only part of the story. When the Government instructed GPs not to keep patients waiting more than 48 hours, the response from many practices was to stop taking appointments more than 48 hours in advance all together, even if patients wanted them. Is not this merely another target that is being achieved only by moving the goalposts?

No; that is simply not true—it is not the case. The Government have issued no such instruction. If the hon. Gentleman's case rests on some instruction that we have issued, I am afraid that he will be disappointed. The Department of Health has issued no such instruction.

Foundation Hospitals

9.

What recent representations he has received in relation to his plans for foundation hospitals; and if he will make a statement. [109808]

Representations have been received from a number of organisations and individuals about NHS foundation trusts. The Health and Social Care (Community Health and Standards) Bill, which was published on 13 March, sets out our legislative proposals for NHS foundation trusts.

The Government's commitment to a primary care-led NHS with high national standards and free from excessive bureaucracy is most welcome, but does not the foundation hospital ideology run directly counter to those values? Is not the Secretary of State engineering a US-style system of health care rooted in market morality and private provision that is not old values in a new setting, but a mistake of fundamental historic importance—a Trojan horse for Sedgefield privatisers and Darlington money changers, perhaps? [Interruption.]

I got the impression that my hon. Friend was not too enamoured of the proposals. There is a fundamental difference, however, between the US system and the English and British system, and as long as this Government are in power, that will certainly remain the case. Our system is free at the point of use and it treats people according to their need, not their ability to pay. Anybody who wants to advocate the American system, as some Opposition Members do, needs only to look across the Atlantic to see what happens when profit is put before the interests of patients. Some 40 million Americans have no health insurance policy whatever. More charges for patients are not a Labour policy, but a Tory one. That is not what this Labour Government advocate or what NHS foundation trusts are about.

In his Budget statement, the Chancellor said that we needed to recognise local and regional conditions in pay and that the remits for the pay review bodies would have a stronger local and regional dimension. How will the Chancellor's regional pay operate in the NHS and what additional freedoms will foundation hospitals have in setting pay and conditions?

It is right, as my right hon. Friend the Chancellor of the Exchequer said, that we need to recognise that there are different labour market conditions in different parts of the country. That is already recognised and, incidentally, it has been recognised for many years, if not decades, in the NHS pay system. For example, we have a London allowance, although we do not have a Darlington allowance or, for that matter, for the information of my hon. Friend the Member for North-West Leicestershire (David Taylor), a Sedgefield allowance.

What the hon. Gentleman should know—I hope that he recognises this—is that the "agenda for change" pay system that we have agreed with the NHS trade unions has two fundamental elements. First, there is a national framework of pay to guarantee equity in the system, which ensures, for example, that two nurses working in different parts of the country can be guaranteed broadly the same benchmark level of pay. However, the system also recognises that because there are different labour market conditions, there should be some local flexibility. That is what the Government negotiated with all the NHS trade unions—Unison, GMB and the Transport and General Workers Union. As I said, I am pleased that the first two of those unions and the Royal College of Nursing and the Royal College of Midwives have given the go ahead to that. Incidentally, that "agenda for change" pay system will apply to all NHS foundation trusts.

We naturally welcome it when the Government are converted to the importance of market solutions to the problems in the public services. We now have the Chancellor's regional and local pay, the Prime Minister talking about co-payment, PFI elevated to a neo-religious movement, PCTs purchasing from private providers, including private hospitals, and opt-out foundation hospitals on the way—all aimed at greater diversity in provision. The Secretary of State may recall telling the House that

"by and large, we thankfully have one monopoly provider and that is the NHS. As long as a Labour Government are in power, that will remain the position."—[Official Report, 26 June 2001; Vol. 370, c. 500.]
Just when did he decide that a monopoly provider was a bad thing?

What characterises markets—as I am sure the hon. Gentleman understands, given that he is, to use his own description, an unreconstructed Thatcherite free-marketeer—is the ability to charge, which is precisely what he is advocating. It is not what this Labour party or this Labour Government are advocating. [Interruption.] The hon. Gentleman says that that is not what he is advocating. I believe that just before Easter he produced his own patient passport proposals, which clearly set out his determination to develop what he called a "self-pay market" in which more and more people would pay for their treatments in hospitals and in other settings. That is a Conservative policy, not a Labour policy; it is what he wants to do, not what this Labour Government will do.

Is my right hon. Friend aware that the greater autonomy, independence and accountability at the local level that lies at the heart of his proposals for foundation hospitals is widely accepted by Members on these Benches? Is he also aware that we welcome greater local accountability and the extra £40 billion that he has achieved from the Treasury? Does he agree that we shall need that local accountability in order wisely to spend that money over the next few years, and that it is about as much money as can be wisely and effectively spent by hospitals, be they foundation or otherwise? Will he therefore consider introducing the extra borrowing requirements that form part of the present proposals as reserve powers that could be activated later, in better circumstances, by an affirmative vote of the House? That would make it a lot more acceptable all round.

I am grateful to my hon. Friend for his support for the principles of earned autonomy and greater freedom for NHS hospitals: that must be the right way forward. As far as the borrowing powers are concerned, I do not think that that would be a sensible thing to do. If we are to have genuine freedom among NHS providers, that is exactly what it should be.

I say to my hon. Friend and to other right hon. and hon. Members that the NHS foundation trust policy is part of the NHS plan reform programme to open up the NHS so that it can provide more responsive services to the local communities that receive them. The only way of doing that, having put the national standards and inspection systems in place, is to ensure that the local communities who receive those services, and the local staff who provide them, have a greater say. Although these hospitals will continue to be NHS hospitals, they will have much greater freedom from day-to-day interference from Whitehall, so that they can get on with the job of developing services that are more attuned to the needs of local communities, particularly deprived areas that all too often have not had the best standards of service, but the poorest.

Can I say to the Secretary of State that I fully support the concept of foundation hospitals because of the responsible freedoms that it gives to the management of the trusts that are applying for foundation status? The Macclesfield acute hospital, which is part of the East Cheshire NHS trust, is interested in foundation status. It is a three-star trust and hospital. Will he give that application a fair wind?

The hon. Gentleman has a track record of supporting national health service principles and institutions. He has been closely associated with the NHS in his local area. Of course, we will consider all the applications favourably. He knows that, to date, 32 NHS trusts have applied for NHS foundation trust status. I am currently assessing those applications. We intend that, over a four to five-year period, every NHS hospital should have the opportunity of becoming an NHS foundation trust hospital, precisely so that it has the opportunities and freedoms that go with improved performance in the NHS. We set that out in the NHS plan. We said that there would be a process of earned autonomy. The more performance improves, the more freedom will be earned in the NHS. When I meet NHS staff, managers who are responsible for running local services and representatives of local communities, they all say that they want the ability to get on with the job of providing improved, responsive services to the local community. That is precisely what we should encourage.

Given the official Opposition's policy on the NHS, does not their enthusiastic support for foundation hospitals give my right hon. Friend cause for the slightest concern about his proposals? Should not we concentrate on our successful policy of ensuring that all NHS services are brought up to the highest possible standard rather than allowing the 30 or so allegedly best performing hospitals effectively to become free-standing health corporations?

I think that my hon. Friend knows that that is not our policy. Much mythology surrounds NHS foundation trusts. I do not believe that it applies to my hon. Friend, but people initially claimed that only half a dozen or a dozen NHS foundation trusts would be formed. That is not and has never been the case. Our intention is to ensure that every NHS trust gets the opportunity to become an NHS foundation trust. We will put in place the measures, support and assistance, including the extra financial help that is needed, to help raise standards of performance of organisations that are frankly not doing as well as they should.

As my hon. Friend knows, it is a myth that we have a one-tier health-care system in our country. We do not. Some organisations are capable today of using the extra freedoms that NHS foundation trusts will give them, others need extra help to put them in that position. We shall do that and ensure an equity guarantee so that every part of the NHS has the opportunity of taking advantage of the extra freedoms in a framework of national standards and a national system of inspection. Most important, the system is based on the NHS values that the Labour party supports—care for free that is based on need, not ability to pay—not the charging that the Conservative party advocates.

What will the effect of the proposals be on hospitals that are already in difficulties, for example, the Royal United hospital in Bath? There is no problem with its surgical, medical or nursing care, but it has huge historic problems with disastrous management. How does such a hospital compete when it has a financial millstone round its neck every year? How does it get to the starting point?

No Labour Member suggests that NHS hospitals should be forced to compete. That happened in the old NHS internal market, which I helped to get rid of. I certainly do not advocate bringing it back. I know about the problems in the hon. Gentleman's area and in the Bath hospital. Some hospitals are in a different position from others and we therefore need different strategies according to the hospital's individual circumstances. The hon. Gentleman knows that the history of underperformance—not by the staff who are doing a fine job in difficult circumstances, but sadly by the people in charge of the hospital—is the reason for our advocacy, through the NHS franchising system, of bringing in new management to turn the hospital around. When we have operated the franchising policy and brought in new management, it has had a dramatic impact on the performance of the relevant hospitals.

It is worth pointing out that when we introduced star ratings, which set out the relative performance of NHS hospitals, several received a zero rating. Subsequently, three quarters improved their performance precisely because of the sort of measures that we are taking. We will continue to give help, support and advice, including extra financial support, to hospitals such as the hon. Gentleman's that are in difficulties.

I think that I ought to try to make a supportive comment at this stage. My right hon. Friend knows that I am attracted to some of the Government's ideas that he is exploring, although there are other aspects of this policy that I am profoundly worried about. Will he clarify the confusion over the eligibility for trust membership? I have a close personal friend—who is known to one or two other people here as well—who has, to my knowledge, been in hospital in at least 10 different locations in the last three years. According to the guidance in the Bill, he would be eligible to stand for election as a trustee in all those separate hospitals. Could he do that, if he were so motivated—he is certainly very motivated—and will my right hon. Friend clarify the exact constituencies that will be used to elect the boards of trustees?

I know that my hon. Friend takes a close interest in these issues, and that he is attracted by certain aspects of the proposal if not by the proposal in total, although I keep working on him and trying to persuade him that it is a good idea and not a bad one, and that it is very much in keeping with the values to which both he and I subscribe. On his specific question, he will be aware, having read the Bill, that the governance structure of NHS foundation trusts works like this: the majority of places on the board of hospital governors are reserved for members of the local community. It is possible for an individual NHS trust, in putting forward its proposal to become an NHS foundation trust, to extend the franchise still further—for example, to patients who have used the hospital in question—but that will be a matter for the NHS trust to determine. My hon. Friend will also be aware that places on the board of governors are reserved for members of staff, which is important precisely to ensure that local members of staff, who, in the end, are responsible for delivering the services, also have some control over how those services are delivered. Finally, the primary care trusts will also be represented on the board of governors, precisely to address the concerns that were raised earlier. That must be right, because if we want to move to a system that has more locally responsive NHS services, we have to have greater local democratic control. It is good enough for local leisure centres; it must be good enough for local health services.

Angiogram Services

10.

If he will make a statement on waiting times for angiogram services. [109810]

The national service framework for coronary heart disease goal is for a maximum three-month wait for angiography. NHS and New Opportunities Fund capital investment totalling £125 million is now putting in place more than 80 new or replacement angiography suites to support faster diagnosis. Ensuring rapid reductions in angiography waiting times is a priority for the three-year local delivery plans.

I am grateful for that answer, but could I just tell my hon. Friend about the case of one of my constituents? He was in hospital recovering from a heart attack and was due to have an angiogram a day later. He was then discharged, however, and returned home. He subsequently received a letter saying that it would be more than a year before the angiogram would be carried out. I have taken the matter up with the health authority and it tells me that one of the reasons that it is not going to be able to meet its heart surgery waiting time targets is because of this huge blockage in getting diagnoses through angiograms. Will my hon. Friend do all that she can to ensure that our commitment to better and faster treatment is matched by a commitment to better and faster diagnosis?

My hon. Friend is absolutely right. The whole of the patient journey has to be improved in terms of access to services, whether that involves diagnostics or treatment. I know that there has been a particular problem in his area. It lost one of its cardiologists last year, but that vacancy has now been filled and it has funding for a third consultant in that field, which should mean that the angiography should be able to proceed much more quickly. I would say to my hon. Friend, however, that in 1997, only 52,000 angiograms were carried out in this country, compared with the 80,000 carried out in 2001. There is, therefore, clearly more capacity in the system, but we have to build on that even more to ensure that patients get treated as quickly as possible.

Does the Minister agree that, when dealing with patients with heart disease, the sickest must be treated quickest? Does she at least acknowledge that there is a danger that, in meeting elective angiography waiting time targets for the least urgent patients, critical patients could be made to wait longer? Does she think it sensible or ethical, for example, that a patient with critical ischaemia who is at risk of heart attack or sudden death should wait at home for weeks for a day-case slot for angioplasty, or occupy a hospital bed for days or even weeks, running the same risk, while waiting for an angioplasty? What is the Minister going to do about that distortion of clinical priorities?

The hon. Gentleman knows well that clinical priority is always the most important issue in the national health service. He will also know that, because we set targets for heart surgery, this year there will be a maximum six-month wait for such surgery. We have now set targets for angiography. Those targets, together with performance monitoring, shows that we are determined to bear down just as hard on the diagnostic part of the patient journey as on the surgery part. The hon. Gentleman says that targets are not the right way to proceed in the NHS. He will know as well as I do that without targets thousands of people who need heart surgery would not be seen. He knows fine well that clinical priority is always the most important issue for the NHS, but we need to ensure that we make progress at every stage of the patient journey.

Bio-Defence

11.

What resources the Health Protection Agency will devote to bio-defence issues; and if he will make a statement. [109811]

The Health Protection Agency brings together for the first time the combined resources of the key organisations to fight potential threats to human health. The level of activity and resource deployed against biological threats will vary depending on the nature and scale of the threat.

I am grateful to the Minister for that answer, but does she recognise the concern that, because the Health Protection Agency deals with all infectious diseases, including AIDS and tuberculosis, bio-defence is only a small part of its responsibilities? Is it right to have separate responsibilities for bio-defence for our armed forces and for the civilian population? What reassurance can the Minister give that bio-defence, which is vital at this difficult time, will get real attention from the Government? Would it not provide more reassurance if we had a specific Minister with responsibility for homeland security, including bio-defence issues?

This is an extremely important issue, and I am delighted to give the reassurance that the hon. Gentleman seeks. We are bringing together in one agency all the different agencies that have been responsible for chemical and biological issues, including the Public Health Laboratory Service and the Centre for Applied Microbiology and Research, as recommended by the chief medical officer in his strategy "Getting Ahead of the Curve". That brings together the skills, expertise, knowledge, facilities and resources, so that our services for health protection can be much more effective than they would be if they were spread out over a number of different agencies, as in the past. Whether the threat is naturally occurring, such as SARS, or a deliberate release of a biological agent, the same good, robust public health systems must be in place for notification, surveillance, reporting and treatment. Thanks to the NHS and the new Health Protection Agency, services in this country are some of the best in the world.

When highly contagious diseases were much more common in Britain than they are now, the national health service had the capacity to cope. We even had isolation hospitals, which are now closed. Given the pressure on capacity throughout the national health service, can my hon. Friend assure me that we could provide the beds to cope with a serious outbreak of a disease such as SARS without resorting to the measures that China is having to adopt by building extra capacity?

I am happy to give my hon. Friend that assurance. We have 25 centres with specialist cross-infection facilities. So far, the strategy that we have adopted in this country is proving extremely effective. We ensure that the whole of the NHS has proper information, is on alert and is in touch daily, and we provide the public with information about what they can do. That enables us to contain cases. We give people suspected of SARS appropriate treatment and ensure that they are isolated, so as to minimise the contacts that they make.

Primary Care Targets

12.

What proportion of targets in the NHS plan relating to primary care he expects will not be met. [109813]

Given that the Minister and his Department are now more than half way through their four-year period to deliver the Government's health targets set in 2000, none of which has yet been assessed, surely he cannot dispute that it is proof of the Government's incompetence that he will not say which of those targets he expects not to meet. What confidence can the tax-paying public have that the Government will meet any of these targets when the Department's own figures show that it missed a whopping 31 per cent. of the 1998 targets, scandalously failed to give any information on a further 27 per cent. of those targets, thus missing a staggering total of 58 per cent., which is more than half the Department's 1998 targets?

The hon. Gentleman seems to think I said things that I did not say. I said "None".

We have a number of targets in the NHS plan, some of which have already been met. Many are challenging, but we are on course to meet them. What is certain is that they are conditional on extra investment in the NHS, which is partly funded by the 1 per cent. national insurance contribution. As the hon. Gentleman voted against that, he is not really in a position to talk about targets in the NHS.