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Mr. Milburn: All I can say to the hon. Gentleman is that, if the health authority's proposals come to Ministers, they will of course be judged in the context of the White Paper. However, I understand that the health authority claims that the proposals, which are fully supported by the community health trust, aim to tackle fairness of access to services. Our White Paper clearly states that there should be an end to unfairness and that high standards should be available to all patients. I expect that the hon. Members for Witney and for Oxford, West and Abingdon would support that principle. I understand that, even without any financial pressures, the health authority and the NHS trust believe that change would have to be made to ensure a fairer distribution of health care in the county.

The health authority has stated that there are considerably more community hospital beds for people aged over 65 in the south and west of the county than in the north. Clearly, those are difficult issues, which will

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need to be considered carefully. As I said, they will be considered within the policy context of our White Paper, "The New NHS". There is no doubt that community hospitals will be part of our vision for the NHS. As the hon. Member for Oxford, West and Abingdon rightly said, nobody benefits if people are admitted to hospital unnecessarily or are kept in acute hospitals longer than necessary. Waiting lists get longer and hospital services become stretched to the limit.

Much work is being done to provide imaginative alternatives to traditional rehabilitation and recuperation services which meet patients' needs. However, we need to ensure that access to such services is dependent not on where patients live but on meeting their needs. Again, if proposals come to Ministers, we shall judge them in the context of that principle.

We currently do not have enough evidence to stipulate whether intermediate care should be provided through community hospitals or in the patient's home. There is a need for better evaluation as models of care develop. In particular, the health authority will need to consider how community hospitals best fit in with acute hospitals and other community facilities to ensure the best balance of emergency, planned and rehabilitation care.

Dr. Peter Brand (Isle of Wight): The Minister has highlighted the national importance of having a policy for community hospitals. Would it not would be a great shame if the hospitals that he has mentioned--which I visited recently--were to close and the opportunity to use the set-up in Oxfordshire as a national pilot for a more integrated health service were lost?

Mr. Milburn: As I said, first, there is no uniform community hospital and, secondly, local needs vary according to local circumstances. That is why the health authority and the NHS trusts concerned must be clear about the relationship between community hospitals, acute care, primary care and other NHS services. That is for the health authority to determine following consultation. There is no single national blueprint. If we tried to impose one, the national health service would not best meet local patients' needs, and we want to avoid that result at all costs.

No part of the national health service stands alone. Clinicians, other members of staff and, increasingly, patients have reached that understanding over the past few years. The NHS is an interconnected system. The hon. Member for Isle of Wight (Dr. Brand) is right, and we want more integrated forms of care in future so that patients who need access to hospital services, and, equally, to primary care, rehabilitation and social services, have a greater continuum of care than in the past. In some parts of the country, community hospitals will provide a vital role in providing that form of integrated care, but that is a matter for local determination.

That brings me--sadly, because the debate had been going well--to money. I say to the hon. Member for Oxford, West and Abingdon that the Liberal Democrats

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are playing a tired old record. Time and again, we hear fantasy figures conjured out of thin air. The facts are straightforward: the Government have allocated an extra £2,000 million to the national health service on top of the allocations planned by the previous Government. [Hon. Members: "Hear, hear."] I am grateful for the support for that proposition from the Liberal Democrat Benches, where there is at last a glimmer of reality.

I remind the hon. Member for Oxford, West and Abingdon that it is important that all hon. Members remember what we promised the electorate at the general election. We promised real-terms increases in funding for the national health service, and we are delivering them. The Liberal Democrats promised increased investment of £540 million per annum. That was generous, but we have doubled that. Now the hon. Gentleman is crying crocodile tears and trying to leapfrog the Government's additional investment in the NHS.

I make it clear to the hon. Gentleman that we recognise that Oxfordshire has particular problems. That is why we have allocated an extra £2.8 million to help with the strategic changes taking place in the county. That is why more money was given to Oxfordshire to help with winter pressures than to any other county in the region. That is why, since we came to power on 1 May last year, we have allocated to the health service in the county £20 million more than the previous Government were planning. I hope that the hon. Gentleman will welcome that.

Dr. Harris: It is necessary to point out, for the record, that the cheers for the Minister's statement came from Labour Members--including the Chairman of the Select Committee on Health, the hon. Member for Wakefield (Mr. Hinchliffe)--sitting in Liberal Democrat seats, who are queueing for Gallery tickets. Clearly, the Liberal Democrats would spend more in real terms than the Government, and for the Government to ignore inflation is to ignore reality for patients in Oxfordshire.

Finally, does the Minister agree that it would not be unreasonable for the local NHS executive to make specific cash releasing allocations of extra money to prevent false economies?

Mr. Milburn: That is an extremely good point. As the hon. Gentleman is aware, £65 million was made available for the waiting list initiative and to improve primary, community, mental health and social services. I expect that the region will take account of local circumstances in determining how best to allocate that money for the maximum benefit of patients.

We all want a modern national health service. There is no doubt that community hospitals will have a role to play in some areas. If the matter comes before Ministers, I can assure the hon. Gentleman--

It being Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.

Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.

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Oral Answers to Questions


The Secretary of State was asked--

Multinational Companies (Business Practices)

2. Mr. Michael Clapham (Barnsley, West and Penistone): What discussions she has had with United Kingdom-based multinationals about their business practices in relation to overseas projects. [42497]

The Secretary of State for International Development (Clare Short): I have had many discussions with multinational companies about their investment and trading practices. We have discussed the growing ethical consumer movements, and their focus on core labour and environmental standards.

I have also discussed the welcome support of the major pharmaceutical companies for the roll back malaria initiative. I have had many discussions on the interest of developing countries in attracting beneficial investments, and the interest of companies in supporting development. My Department is consulting widely with the private sector on how we can be best work together to promote those objectives.

Mr. Clapham: I thank my right hon. Friend for that answer, but may I tell her that on 13 May, the day on which Rio Tinto, the largest mining company in the world, held its annual general meeting, the International Union of Chemical, Energy and General Workers published a booklet entitled "Rio Tinto: Tainted Titan", and held a stakeholders' meeting to draw attention to the fact that the company had shown disregard for human rights and for the environment? I agree that it is now addressing those issues, but will my right hon. Friend continue to press to ensure that multinational companies exercise the best practices and have regard for human rights and for the environment?

Clare Short: I can certainly give my hon. Friend that undertaking, but there is definitely a new mood among multinational companies. They are seeking meetings with my Department and, one by one, they are making commitments to human rights and to monitoring their performance overseas. There is a real sea change, and if we encourage that, we could improve standards of protection of the environment and core labour standards across the world. It is an important opportunity.

Rio Tinto had a bad reputation, but it seems to be working to change. I recently gave out the World Aware awards, and the company won one. I was visited by missionaries who had been working in the Philippines and who were critical of the company's record. I arranged that they should meet, but, apparently, Rio Tinto is not in the Philippines any more. All of us, including my hon. Friend, should meet Rio Tinto and get behind those improvements in performance, because they are beneficial to everyone.

Mr. Andrew Rowe (Faversham and Mid-Kent): Can the Secretary of State confirm that her conversations also cover behaviour such as marketing vigorously in overseas

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countries goods that have been banned or found to be dangerous in this country? Will she look at the record of the tobacco companies that flog cigarettes vigorously overseas as they are unable to flog them here, because we understand the dangers? Will she also consider countries that still promote tinned and powdered milk, when everyone believes that maternal milk is infinitely better for children?

Clare Short: I am happy to give the hon. Gentleman an undertaking to look at any issue, but I do not pretend to have invincible power to cause multinational capital suddenly to take on the standards that he advocates. We have all been campaigning to get rid of irresponsible baby milk advertising, which is so destructive. I confess that I have never looked into the tobacco issue in detail, but I am aware of it from press coverage. I will take a look at it.

Mr. Hugh Bayley (City of York): Is my right hon. Friend aware of the remarks of Adair Turner, from the Confederation of British Industry, in favour of international action to combat bribery in international trade? That is a change of position for the CBI. Given my right hon. Friend's support in the White Paper for action to implement the convention of the Organisation for Economic Co-operation and Development on combating international bribery, will she or her Government colleagues be introducing legislation to tackle the problem?

Clare Short: I pay tribute to my hon. Friend for his work in this area. We have a great opportunity, because the OECD has called for companies from industrialised countries to clean up their act, for Governments to cease the practice of allowing bribes in overseas countries to be tax-deductible--it is disgraceful that they ever were tax-deductible--and for it to be made a crime to offer a bribe to a public official overseas. I am keen for Britain and other countries to embrace this opportunity, especially when Governments of developing countries, particularly in Africa, are giving a lead and are taking steps at home. There is no doubt that corruption hurts the poor. We are considering legislation, and I am hopeful that Britain will take a lead.

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