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Mr. Bayley: This afternoon, the Prime Minister told the House that we should not be unduly concerned about 400 children being turned away from paediatric intensive care, because they were all found intensive care beds elsewhere. I am told by the head of a paediatric intensive care unit that, although of course all those seriously ill children were found intensive care beds elsewhere, they were not all found paediatric intensive care beds. Some were placed in ordinary intensive care beds, which are not at all the same thing and which are not designed to meet the intensive care needs of children. Will the Secretary of State clarify the position, and tell the House whether a paediatric intensive care bed was provided for each of those 400 children?
Mr. Dorrell: I remember, when this issue was the subject of intense debate last spring, being engaged in a studio discussion with Professor Sir Roy Calne, who made the clear point that, in his view, the best way of treating a child who did not have access to paediatric intensive care was to provide that child with a place in an adult intensive care unit.
If what the hon. Gentleman says is true, I still rest my case on the proposition that we have put in place an expansion of paediatric intensive care provision--as we said that we would--and the monitoring system for which the Labour party press release calls. In fact, the gentleman whom Labour spokesmen have been so keen to brush aside in their comments this afternoon is the chairman of precisely the monitoring system called for in the press release. We have put all that in place in order to deliver the commitment to parents of young children that children who need intensive care will be provided with such care by the national health service.
Mr. Chris Mullin (Sunderland, South):
Will the Secretary of State give way?
Mr. Dorrell:
I will give way once more on this subject; then I will move on.
Mr. Mullin:
I think everyone accepts that it is not always possible for a particular intensive care unit to accommodate a patient, but does the right hon. Gentleman agree that the 120 miles that a 20-month-old child in Sunderland was taken by ambulance was too far? It was a hazardous journey, as the child was having difficulty breathing. On the way back, the ambulance broke down; had that happened when the child was on its way to the hospital, the outcome might have been different.
Mr. Dorrell:
The hon. Gentleman says that 120 miles was too far, but I am pleased to say that I am told that the child is now at home, out of danger and making a full recovery. It is rather difficult to argue that the distance travelled was too far if the case has a successful outcome. The hon. Gentleman's argument is undermined by what actually happened.
Mr. Chris Smith:
Let me pursue the point a little further. Is the Secretary of State saying that every single
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Mr. Dorrell:
No, I am certainly not saying that. There are numerous examples of clinicians ringing a paediatric intensive care unit to discuss a case, and then agreeing that intensive care is not needed in that particular case. There are a number of reasons why children are refused admission following telephone conversations of the kind that the Labour party has been counting.
If the Labour party would stop making cheap points and listen to the chairman of the Paediatric Intensive Care Society, the hon. Gentleman would find that the statement on the Press Association wires answers his point very directly. As I have said, there are a number of reasons why cases are not admitted to paediatric intensive care following discussion between clinicians. What I am saying is that if, in the opinion of the clinician caring for a child, that child needs intensive care, I imagine that--failing to find any other bed--the clinician would use the emergency bed service which was established precisely to meet the need he feels he has on behalf of his patient. If we use that test--earlier, I invited the hon. Member for Islington, South and Finsbury to define any other test--40 cases were referred, every one of which was offered at least two options.
Mr. Richard Burden (Birmingham, Northfield):
Will the Secretary of State give way?
Mr. Dorrell:
I want to deal with other emergency services.
It is true that, since Christmas, the national health service has been under pressure. I do not seek to deny that; it regularly happens during the first few weeks of the year, and it is not difficult to see why the emergency services are affected in that way. There were two weeks of extremely cold weather at the beginning of the year and there has been a high incidence of 'flu. As a result of those developments, some hospitals have admitted emergency cases at roughly double, and in some cases more than double, their normal admission rate for this time of year. The emergency services have been working under considerable pressure and I pay tribute to the doctors, nurses, therapists and managers who kept the service working through that period to ensure that the emergency need was met.
It is not right to seek to create the impression that nothing has been done to meet the peaks of emergency demand that have been experienced over the past few weeks. Plans have been made and acted on to ensure that the health service meets the peaks of emergency demand. This winter, as it does every winter, the NHS has taken the steps that are necessary to meet those emergency peaks. One such step is to delay less urgent cases. If there is a doubling of the emergency admission need at a hospital, the rational response is to delay some less urgent admissions for a week or two. That has certainly been done.
We have also provided short-term extra bed capacity. In Dartford, we provided an extra 33 beds; in Ashford, an extra 40; in St. Helier, an extra 35; in Poole, an extra 18; in Derriford, an extra 11; in Plymouth, an extra 35; in
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Faced with emergency pressures, the health service has acted rationally by deferring less urgent cases and opening short-term ward capacity, as it planned to do when it thought during the summer and autumn about winter pressures and about how to meet the peaks of demand that are experienced at this time of year. Some other responses have been set out by the National Association of Health Authorities and Trusts in the press release issued this morning which deals with the winter emergency in the health service.
I had hoped that, as that was the subject of the Opposition debate, they might refer to what health authorities and trusts have done to meet the winter peak of emergency pressure. There is a page and a half of specific changes that have been made by health authority and trust managers to meet those peaks. The Opposition have not referred to that report by NAHAT, because, although the health authorities have been under pressure, the report concludes:
Mr. Burden:
The Secretary of State says that all the right preparations were made. If that is so, why did his Department get into such a pickle over 'flu vaccine? Apparently it did not order enough vaccine and issued instructions to hospitals to be careful about which members of staff it was given to, to ensure that enough was available for patients and old people. Is not the result that when 'flu increased--as it is likely to do in winter--more staff than necessary went down with it and there was more pressure on staff numbers and patient care suffered? Why were there no preparations for that? It should have been easy for anybody to predict what would happen during the winter months.
Mr. Dorrell:
The 'flu vaccination programme has been running for many years and, rationally, focuses on those who are at risk. Of course, we all run the risk of experiencing a bout of 'flu, but for most of us there is no serious health risk associated with it. For the elderly and others for whom a serious health risk is associated, 'flu vaccination is available. The health service has pursued that policy for many years.
Mr. Simon Hughes:
I welcome the steps that have been taken since March to improve paediatric and general intensive care. On the best current information, what is the Secretary of State's assessment of whether there are enough paediatric intensive care beds to ensure that no parent runs the risk of his child not being admitted, which is what we all wish? Are there enough intensive care beds throughout the country? If the answer to the second question is yes, something is wrong when people die in hospitals such as Guy's in my constituency after being told that there is no intensive care bed there. The right hon. Gentleman's answer would enable us to judge whether we have arrived or whether we are still on the way to providing the service that the NHS should supply.
Mr. Dorrell:
The problem with the hon. Gentleman's question is that it implies that there is a final answer to
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Our analysis last spring led to the conclusions that I announced at that time. They were widely welcomed in the field and they have been delivered. The Government have made clear their commitment to an expansion of the adult intensive care service. That is why I made two announcements following the Budget. First, I announced a targeted fund to support the growth of intensive care facilities, and especially such facilities for adults, in the next financial year. Secondly, just after Christmas I announced a £4 million fund to bring forward that expansion of intensive care into the current financial year. I announced the distribution of the money and said that it would be used to deliver almost 100 extra adult intensive and high-dependency beds in the last quarter of this financial year. The process is one of growth and assessment of need, but we can never reach the final destination, which is what the hon. Member for Southwark and Bermondsey (Mr. Hughes) implies in his question.
Mental health is a key part of the national health service. The hon. Member for Stockport (Ms Coffey), who is no longer in her place, said that for too long, under Governments of every political complexion, mental health has been the Cinderella service of the NHS. But the Government have raised the priority of mental health and we have made clear our determination to improve the quality of the mental health care that is delivered by the NHS. We have not merely accepted the central recommendation of today's King's Fund report, but have announced our intention to implement it as soon as that is possible, on 1 April.
From that date, the NHS cash distribution formula will reflect the differing needs of different parts of the country for community health services. That central recommendation of the report has been implemented and will lead to increased resources being targeted at mental health problems, especially in inner London. That is the latest of a series of initiatives over the past few years, the effect of which has been to strengthen the commitment and raise the priority that the health service attaches to mental health.
The mental illness specific grant, introduced six years ago, is now supporting about £100 million of extra expenditure by social service departments on mental illness provision. The national health service challenge fund, which I introduced for the first time in the current financial year, has been extended into next year and will then be supporting £25 million of new expenditure by the NHS.
In this year's Budget, I introduced a special fund to improve the provision for mentally disordered offenders, which is a particular problem in inner London, particularly east London and south-east London. That is a targeted fund addressing one of the specific needs
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I have never made any secret of my recognition of the fact that, under Governments of all political complexions, mental health services have not been accorded the priority that we should have seen over the past few years. That is a weakness that the Government have acted to remedy, and I had hoped that the hon. Member for Islington, South and Finsbury would welcome that.
The Labour party's charges on the health service do not add up, but there is something more serious than that about the speech of the hon. Member for Islington, South and Finsbury: as everybody knows, this Parliament does not have much longer to run and, when the election comes, the electorate will ask both major parties and the Liberal Democrats about their policies. Behind all the bluster and cases such as Jennifer's ear and the updated version of that, they will want to know the health policy that the Labour party is offering to the people of this country. When that is the question asked, we are faced with a gaping void.
The first question must be about money. Let me remind the House of the Government's record on financial support for the health service. Since 1979, there has been an increase of roughly three quarters in the real budget available to the NHS. That represents 3 per cent. real-terms growth on average every year over the past 18 years. That is the Conservative's record of commitment to the NHS. I remind the House again of the Prime Minister's pledge to our party conference to continue real-terms growth year on year on year through the five years of the next Parliament.
We then come to what the Labour party offers in reply. The editorial of The Guardian said that the Labour party
"Undoubtedly, despite the problems, the service generally has been maintained".
Faced with emergency peaks, the NHS has taken action to respond and, overwhelmingly, the story is of the service meeting the emergency need that has been placed upon it.
"needs to match the Tory spending promise. Honouring next year's settlement is meaningless--Labour can hardly take away money already promised. What it must do is match the Tory five-year promise: real increases, year on year on year."
That is the challenge that comes from a newspaper that Labour must be hoping will support it in the general election campaign. The same challenge is posed by Conservative Members and Liberal Democrats and all around the community. They want to know whether the Labour party will set out clearly its commitment to a real, growing national health service. The Labour party never answers that question. It dodges and fudges and finds a formula to get around it, but will it answer it? Will it hell. That is the question that will be asked by every elector in every public meeting attended by the hon. Member for Islington, South and Finsbury. They will be asking him why he will not match the Tory party pledge for a real growth in the national health service.
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