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Mr. Richard Burden (Birmingham, Northfield): May I welcome the choice of Birmingham for one of the new NHS direct schemes? Does my right hon. Friend agree that making good-quality advice available 24 hours a day, seven days a week, is a lot better than having market madness and a two-tier health service available 24 hours a day, seven days a week? Does he further agree that NHS direct will help to boost primary care, and will he look with favour on plans soon to come forward from Birmingham for primary care improvements that will ensure that the people of the city receive the health care that they need and deserve?

Mr. Dobson: I am sure that NHS direct greatly benefits the people concerned. It has another merit, in that it will provide job opportunities for trained nurses who because of injury, often back injury, find that they can no longer use their nursing skills to deal with patients. It has many merits. It is clear that many people are willing to ring the 24-hour helpline knowing that it is there for 24 hours. Some of them, because they are considerate of others, are reluctant to go to accident and emergency or ring for a doctor or ambulance. In some cases, people who clearly would not have rung for an ambulance have rung NHS direct and ambulances have been sent round straight away because the cases were urgent. In many cases, nurses have given immediate reassurance to concerned parents, the children of elderly parents and people worried about their neighbours. It has been a great success and I commend the people who have been carrying it out.

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We also promised at the general election that we would conduct an independent review of health services in London. We established the Turnberg review. The report was published and we accepted all its recommendations. With the exception of one or two--far from all--Conservative Members in London, there have been no substantial criticisms of the report or our implementation of it.

As part of our programme to get rid of the divisive arrangements that we inherited from the previous Government on primary care, we have made much progress towards the establishment of primary care groups involving GPs, community nurses and social services. Contrary to Tory propaganda, we reached amicable agreement with the GPs and everyone else concerned.

Mr. Simon Hughes: You gave in.

Mr. Dobson: It is giving in now, is it? The representative of the Liberal Democrats does not believe that the reasonable points that the British Medical Association made on behalf of its members should have been conceded. We should not have given in. We should have stuck it out, behaved like the Tories and ignored the representatives of the profession. That is not the way we operate.

Mr. Hughes: The Secretary of State knows what happened. His Minister of State was faced with the prospect of the GPs making a large protest last week. He negotiated with them the week before and has now delivered primary care groups with seven GPs and a GP in the chair. The groups are meant to represent all the professions and the community. Effectively, they will be run by GPs.

Mr. Dobson: For the first time in the history of our health care, nurses will have a say in what happens in primary care.

Mr. Hughes: The Tories introduced that.

Mr. Dobson: No, they did not. They did not introduce primary care groups in every part of the country. The hon. Gentleman should not reinvent history. He will be claiming that the Liberals invented the national health service next.

Mr. Hughes: We did. [Laughter.]

Mr. Dobson: I have been practising with that fly for some time.

We have other main tasks. We have to provide the staff of the NHS with the education, training and retraining necessary for them to cope with the ever increasing demands of their jobs. We must put in place new arrangements to set and deliver high-quality performance standards across the NHS. We must give more priority to public health and to reducing the inequalities in health that leave poor people ill more often and dying sooner. Once the outcome of the comprehensive spending review

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is published, I shall be able to spell out our new arrangements for continuing professional development for all NHS staff.

Let me give a simple example of what is needed. We all still expect nurses to provide tender loving care. These days, we also expect them to cope with using highly complex, high-tech equipment. They cannot be expected to do that without the necessary training and time for training, including training specific to new equipment. When we took office, we discovered that there is no machinery in the NHS to set performance standards or ensure that they are delivered. Without those arrangements, things go wrong. Nothing is done; people die. That is what happened with the children in Bristol, with breast cancer screening in Devon and Exeter, and with cervical cancer screening in Kent and Canterbury. We are determined to change the NHS, so that such systematic failures never arise again.

Today, the Government are putting quality at the heart of the NHS. We are doing something that no Government have done for 50 years: implementing new mechanisms to set standards, deliver standards and monitor standards. The Government are not prepared to leave quality in the NHS to chance, as occurs at present. Patients deserve a first-class service wherever they are treated.

We shall establish a professional-led National Institute for clinical excellence, to provide authoritative guidance to all health professionals on the latest technologies and drugs. There is no such organisation at present. We shall introduce national service frameworks to lay down what treatment and care should be provided for patients suffering from particular conditions. Except for cancer and children's intensive care, there are no such arrangements at present. We shall place on all local hospital boards the duty of clinical governance, to make sure that standards are met. They have no such duty at present.

We shall establish a Commission for Health Improvement to monitor the performance of every part of the NHS, carrying out a rolling programme of spot checks and troubleshooting. There is no such organisation at present. We shall require all hospital doctors to participate in national external audits. There is no such requirement at present. We shall give all GPs and their patients the right to get information on the success rates of treatments in their local hospitals. They have no such right at present. We shall carry out annual independent surveys of the experience of patients and carers in the NHS, to ensure that their voices are heard and heeded. There are no comparable national surveys at present.

I emphasise that all those proposals have been welcomed by representatives of the professions, which reflects both their commitment and the practical common-sense nature of what we propose. They are some of the practical steps that we have been taking to improve the NHS. We are equally committed to improving the health of the public and reducing inequalities in health. Under the Tories, the gap between rich and poor widened, as did the gap in health. That is true, and I shall give just one example.

In the early 1970s, there was scarcely any difference in the number of deaths from heart disease among men in social class 1 and those in social class 5. Today, men in social class 5 are three times more likely to suffer from heart disease. That constitutes a widening of the

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health gap. We are determined to reduce that gap, and the NHS has much to contribute to that process. However, other Departments' programmes will help even more.

Unemployment makes people ill. Our investment of £3.5 billion in the new deal for jobs will help improve the health of the people involved. Bad housing makes people ill, so our £900 million investment in new housing from the takings from the sale of council houses will provide decent homes and improve the health of the families concerned. Low pay makes people ill. Our national minimum wage will improve the health of the worst-off workers. Those and other measures are geared to helping the most deprived families and most deprived neighbourhoods--both have been neglected for far too long.

All those changes simply apply the basic socialist principles of the national health service to modern circumstances. Some people do not like that. Some so-called experts make a living travelling around the world attacking the principles of the NHS and demanding that we abandon its principles and charge everybody for everything. When they are in Britain, they ignore the evidence of the intrinsically cost-effective NHS. When abroad, they ignore the evidence of the intrinsically more expensive systems in the countries that they visit. They are a group of self-perpetuating ignoramuses. However, they are wasting their breath and whoever is paying their travel bills is wasting his or her money.

At the general election, the British people voted for the NHS--free when they need it, paid for by the taxpayer. The Government accept the verdict of the British people. Tories may argue, as some do, for a different system, but the Government are committed to the one we have. Today, we salute the people who work in the NHS--people of all colours, of all races, of all religions and of none. For every minute of every hour of every day of the past 50 years, they and their predecessors have bound up the wounded, healed the sick, cared for the afflicted, comforted the dying and consoled the bereaved. Frustrated by lack of resources and obstructed by archaic systems of organisation, they have never thrown in the towel. They have fought the good fight, but they have seldom received rewards to match their contribution to the well-being of our country.

Fifty years ago, our fathers and mothers--in some cases, our grandfathers and grandmothers--made an act of faith: they agreed to found the national health service. They had faith in the future, faith in the health care workers and faith in the principles of the welfare state. Today, as a country, we are rich beyond the wildest dreams of people in 1948. It now falls to us to renew and modernise the NHS, so that it is fit to face the challenge of the new century and the new millennium. We must not flinch or falter now.

Fifty years ago, people could only hope that the NHS would work. Fifty years later, we know that it works. We have experienced its benefits. We know that Nye Bevan was right when he wrote:

It is our job now to make sure that we renew the national health service, so that future generations experience the benefits that he gave to us. Nothing less will do.

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