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Mr. Charles Kennedy (Ross, Skye and Inverness, West): Yesterday's announcement of additional funds for the health service is welcome news indeed. I also agree--as, I am sure, do Members in all parts of the House--that if we want to take the country with us, it makes sense to proceed with a view to the future rather than merely fighting past battles. Does the Prime Minister accept that that process would be assisted if he acknowledged that those of us who have argued for the injection of roughly the sums announced yesterday have not been behaving irresponsibly, as that is now the policy of Her Majesty's Government?

Will the Prime Minister also acknowledge that, in conducting his review, he should be upfront with the profession and the public, and openly admit that waiting

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list targets have distorted clinical priorities? He has cited the deplorable state of affairs in which 5,000 elderly people are languishing in hospital because no other facilities are available. Does he accept that the position is not helped by the fact that the Government have yet to respond to the findings of the royal commission on long-term care for the elderly, and that that too must be seen as part of the process? The response would be incomplete if it did not take account of those findings.

Will the Prime Minister confirm, given that the review will be rather centralised, that the extra money will find its way down to the regions--to both trusts and health authorities? All too often, extra money announced at the centre is not deployed as effectively as it might otherwise be because of insufficient flexibility locally.

At present many trusts are in deficit, and are having to conduct reviews as we speak. As we heard at Prime Minister's questions, closures are imminent. Given the extra money that has been announced, will the Prime Minister instruct the trusts to put their reviews on hold?

Finally, may I raise the vexed issue of appointments to trusts? A commission is being established for the appointment of Cross-Bench peers. Is that not a good precedent for appointments to NHS trusts? Could they not be dealt with by an independent commission, and could not political fingers be kept out of this particular pie?

The Prime Minister: On that last point, the Secretary of State is announcing our proposals in response to what Dame Rennie Fritchie said.

The findings of the commission on long-term care will be dealt with as part of the comprehensive spending review. Obviously, very important issues are involved. The £2 billion will go down to primary care groups and trusts: my right hon. Friend the Secretary of State for Health will explain how that will happen when he makes his speech.

I think that we must make a distinction. The right hon. Gentleman asked me to put on hold any hospital changes in the country. Of course I do not know the individual circumstances of each case that is put to me, but there will be circumstances in which reorganisation is the right way forward. We cannot freeze health care in exactly the same way for ever. However, there are also areas in which reorganisation will be specifically a result of problems with resources.

The differences between those two cases are exactly what we need to explore with people. Our proposal for a partnership for change, which will lead to the publication of a plan in July, will not work unless people are prepared to make difficult choices as well as easy ones in the health service. It will not work unless people are prepared to accept, for example, that it is important for us to see how elderly patients are best dealt with in the service. What is the right system to ensure that we give them the level of care that they want?

I welcome the right hon. Gentleman's approach in saying that this is the right way: to have the money upfront, and then to say, "Let us sit down with those in the NHS to work out both how we spend the money, and how we make the necessary changes." The right hon. Gentleman's constructive approach stands in very marked contrast with that of the Leader of the Opposition.

Mr. David Hinchliffe (Wakefield): Anyone who cares about the NHS and its basic principles will warmly

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welcome yesterday's announcement of the huge funding increase and today's statement: they are in marked contrast with the position of the Conservative party, which appears to have completely given up on the NHS and which wants to push people into the private sector. It is interesting that, during the last Tory Opposition-day debate on the health service, two Conservative Back Benchers were present at the end of the Front-Bench speeches. There is no interest on the Conservative Benches.

May I press my right hon. Friend on three specific points? First, he will accept that, in putting that money into the NHS, we need to make best use of the resources that we have. On that basis, will he look at whether the organisational structure that we inherited from the Conservatives--the internal market, the split between trusts and health authorities--is the best arrangement? There is much evidence nationally of waste as a consequence of that split at local level.

Secondly, my right hon. Friend referred to the relationship between the NHS and social services. Will he look at combining the two organisations, as they are combined very successfully in Northern Ireland?

Thirdly, will my right hon. Friend look at the way--[Hon. Members: "Order."] I will conclude on this point.

Madam Speaker: The hon. Gentleman certainly will.

Mr. Hinchliffe: I will, Madam Speaker.

Will my right hon. Friend look at the way in which, in certain areas, waiting lists are artificially created to cause demand for private treatment by the same consultants who treat people in the NHS locally?

The Prime Minister: I am sure that the items to which my hon. Friend draws attention can be looked at. Of course, primary care groups and trusts are a way of trying to preserve the concept of devolved budgets, which was the one part of the internal market that had some merit, but to get away from the idea of the paperchase for the contract, which did much damage. We want to try to keep that co-operation locally and to keep devolution, but to do away with the vast bureaucratic expense.

Several hon. Members rose--

Madam Speaker: Order. The last questioner was the Chairman of the Select Committee on Health. I will not have further long questions. I ask for brisk questions now. I have today's business to safeguard.

Mrs. Virginia Bottomley (South-West Surrey): Leading the health service and health care generally must be one of the greatest challenges of our generation. I am not sure that it inspires people to know that politicians are trying to take over all the leadership.

The Prime Minister talks about the professions, but not about health service managers. If all the credit is taken by politicians, but, whenever there are problems, managers are named and shamed, it has a particularly poor effect. "Health Chiefs Face the Sack" is not a helpful headline. The Prime Minister has recognised managers and leaders in industry. Will he please give recognition and support to health service managers in health care?

The Prime Minister: Of course management in the health service is important. The managers are a vital part

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of the service, but I draw the right hon. Lady's attention to the fact that the NHS Confederation welcomed the extra money that we put in yesterday and the offer of partnership for change. It is simply sad that the Conservative party has set its mind against it.

Dr. Howard Stoate (Dartford): As someone who still works part-time in the health service, may I say that the vast majority of NHS workers in my constituency of Dartford both recognise and welcome the need for substantive changes in their working practices? What reassurance can my right hon. Friend give to the 1 million-plus people who work in the health service that he recognises their extremely valuable contribution and that he will continue to support them in the way that he has so far?

The Prime Minister: I certainly give that assurance. That is one of the reasons why we put in the additional money. Let us look at just one group in the NHS, the nurses. As a result of the additional staffing pay, we have had a 25 per cent. increase in the number registering for nurse training. We also made a very substantial pay increase--I think the largest that has been made--to 60,000 grade E nurses. We are trying to reward people in the health service better, but we must also look at more flexible working practices and more flexible use of people's working time. We must see how we can improve the quality of life for the staff in the health service, too.

Sir Brian Mawhinney (North-West Cambridgeshire): Is the Prime Minister aware that, although he is right to draw attention to the service distortions that need to be dealt with, there was one alliterative challenge that he did not include in his list: patient choice. Was that an oversight, or a policy decision?

The Prime Minister: No. I do not know exactly what part of patient choice the right hon. Gentleman is referring to. If he is referring to the split between public and private--

Sir Brian Mawhinney: No.


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