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Mr. Graham Brady (Altrincham and Sale, West): Will the Leader of the House make time, during one of the Prime Minister's occasional visits to the Chamber--perhaps this afternoon following his statement--for him to make a clear statement on his determination to force the country to scrap the pound? He has made it clear in his memo that he regards the politics of the matter as overwhelmingly in favour of Britain joining the euro. Will he explain to the House how that can possibly be the case, given that the European Union itself has found that 70 per cent. of the British public oppose British membership of the euro? Will he explain to whom the policy is favourable and why he wants it introduced so quickly?

Mrs. Beckett: As the hon. Gentleman knows, my right hon. Friend the Prime Minister answers more parliamentary questions than did his predecessor and, as a consequence, is in this House more often. The issue to which the hon. Gentleman refers has been aired frequently and ad nauseam, and we certainly will not debate it when we return after the recess.

Dr. George Turner (North-West Norfolk): My right hon. Friend announced today that we shall debate the Rural White Paper in the context of a report from the Select Committee on the Environment, Transport and Regional Affairs. Although my constituents welcome much of what the Government have done, they are impatient for further action. After 18 years of Conservative Government, with the closure of schools, post offices and shops and the reduction in bus services, they want this Government to spend every penny that the Chancellor has made available. When will we debate the White Paper itself, so that the Government can turn promises into action for rural areas? We are all fed up with the Tories, who just want cuts--the same old cuts, the same old Tories.

Mrs. Beckett: I am aware of the impatience in the countryside to see the Government's further proposals and to know what would be put in jeopardy if the Conservative party were elected. I anticipate a debate on this matter, perhaps during the autumn.

Mr. Michael Fabricant (Lichfield): When we return, may we have a debate on the Northern Ireland peace process? The Leader of the House will be aware that not a single bullet nor ounce of Semtex has been handed over, and that punishment beatings continue. Does she think it

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right that James McArdle should be released after serving just two years for killing two people in docklands? Is one year per person just?

Mrs. Beckett: I have nothing to add to what I said before: the British people's priority is the peace process.

Mr. Andrew Dismore (Hendon): Is my right hon. Friend aware that, last Friday, the Divorce (Religious Marriages) Bill (Lords) was blocked by the right hon. Member for Bromley and Chislehurst (Mr. Forth), causing widespread anger and disappointment among my Jewish constituents and the wider Jewish community? That modest measure would have brought great comfort to a relatively small number of Jewish women who are chained in marriage by their husbands, who refuse to grant them a divorce. Can my right hon. Friend give them any hope that somehow this measure can be reintroduced at a later stage?

Mrs. Beckett: As my hon. Friend knows, the Government are sympathetic to the view that he has expressed and are concerned about that matter. I can undertake that we will consider it, but he will know that there are difficulties. However, we did not object to the Bill.

Mr. Stephen O'Brien (Eddisbury): Having waited seven months for the Government's response to the reforms proposed by the Neill committee and noting that, in the Government's spin, they say that they will curb the burgeoning hordes of special advisers but make no promise about the date for introducing the necessary legislation before the general election, can we hold an urgent and early debate on the reason why the Government seek to reject a raft of the reforms proposed by the Neill committee?

Mrs. Beckett: Lord Neill has welcomed the degree to which the Government have accepted his recommendations. It is yet again typical that the Conservative party prefers to talk about special advisers, memos and leaks than about the health service, education and jobs, as I am sure the British people have noticed.

Mr. Huw Edwards (Monmouth): Can my right hon. Friend find time to debate the potential use of objective 1 funds, which have been greatly welcomed by industry and agriculture in Wales, so that we can compare this Government's record for Wales in securing objective 1 funding and matching it with £421 million over three years with the record of the previous Government, who did not apply for one penny?

Mrs. Beckett: My hon. Friend is entirely right. I hope that there will be opportunities to air that important issue in the overspill session. I cannot undertake to find time for a special debate on it, but he might like to seek one in Westminster Hall, and he might remind people who was the last Secretary of State for Wales under the Conservative Government.

Mr. John Bercow (Buckingham): May we please have a full day's debate in Government time on early-day motions 1042 and 1044, which relate to the possible amendment of the Local Government Act 1988?

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[That this House commends the constitutional propriety of the 24 Labour, three Liberal Democrat, six Scottish Nationalist and two other Right honourable and honourable Members from Scottish constituencies, namely the Right honourable and honourable members for Banff and Buchan, Angus, Tayside North, Argyll and Bute, Dumbarton, Carrick Cumnock and Doon Valley, Kilmarnock and Loudoun, Ochil, Galloway and Upper Nithsdale, Strathkelvin and Bearsden, Coatbridge and Chryston, East Lothian, Edinburgh East and Mussleburgh, Eastwood, Edinburgh Central, Dunfermline East, Dunfermline West, Fife Central, Anniesland, Baillieston, Kelvin, Pollok, Caithness, Sutherland and Easter Ross, Ross Skye and Inverness West, Renfrewshire West, Midlothian, Moray, Cumbernauld and Kilsyth, Perth, Paisley South, Clydesdale, Hamilton South, Livingston and Linlithgow, who abstained on the vote on 25th July to preserve section 28 of the Local Government Act 1988 in England and Wales, an issue which is devolved to the Scottish Parliament in relation to their own constituencies.]

Does the right hon. Lady accept that such a debate would provide an excellent opportunity for 28 Labour Members who represent Scottish constituencies to explain why they supported the retention of section 28 in England and Wales, but its abolition for their own constituents?

Mrs. Beckett: All I can say is that I have nothing to add to what I said before. The Government will return to the discussion of such issues in time.

Dr. Julian Lewis (New Forest, East): In answer to the question asked by my hon. Friend the Member for Altrincham and Sale, West (Mr. Brady), the Leader of the House said that the Prime Minister had frequently outlined the overwhelming political case for the euro in public--a case to which he apparently adheres to in secret. Is not it a fact, however, that all that has ever been said in public is that there is no constitutional bar to Britain joining the euro, which is a very different matter? Will she seek to secure from the Prime Minister an honest statement of the reason why he secretly thinks that there is an overwhelming political case for signing up to the single European currency?

Mrs. Beckett: My right hon. Friend has repeatedly made the Government's position clear. The Conservative party should not encourage debate on that matter because the more we hear about its pledge to keep the pound for one Parliament, but not necessarily for ever, the sillier it sounds.

Mr. Owen Paterson (North Shropshire): The Leader of the House grossly underestimates the strength of feeling, as expressed in early-day motion 1027, which was mentioned earlier by my right hon. Friend the Member for North-West Hampshire (Sir G. Young).

The Home Secretary escaped two days ago only by a slippery and semantic use of the word "it". If he came to the House, we could talk about police numbers because, in April, my police authority was 101 police officers down on April 1997. We could also analyse his use of the words "more", "extra" and "new" when he discusses police officers.

Mrs. Beckett: These matters have been extensively aired and, no doubt, they will be again. I have nothing to add to what I have said already.

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Finally, Madam Speaker, on behalf all those who regularly attend business questions, may I say that we shall miss you?

Madam Speaker: Thank you very much.

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NHS Plan

1.14 pm

The Prime Minister (Mr. Tony Blair): With your permission, Madam Speaker, I should like to make a statement on the national health service plan.

The NHS was the greatest achievement of the post-war Labour Government. It was based on one solid founding principle: health care should be given on the basis of people's needs, not their wealth. Some objected to that principle then, some would like us to abandon it today, but this side of the House will never abandon what was one of the greatest civilising acts of emancipation this country has ever known. Our task is instead to provide both the money and the reform to make the health service and its founding principle live on and prosper in the 21st century.

As to investment, in March we took a profound decision as a Government. We had sorted out the public finances. Debt service payments were down. Spending on unemployment benefits was down. It was the tough decisions that we took on the economy that gave us the opportunity to make this historic commitment to the national health service--an average real terms increase in spending of 6 per cent. Over five years, the NHS will grow by a third in real terms, the largest ever sustained increase in its funding.

The plan shows how that money will make up for years of underinvestment. Over the next four years, it will provide 7,500 more consultants, a rise of 30 per cent.; 2,000 extra general practitioners; 450 more GP trainees and more to come after that; in time, 1,000 more medical training places each year--on top of the 1,000 already announced--a 40 per cent. increase since 1997; and more than 20,000 extra qualified nurses, to add to the 10,000 extra already in post, making 30,000 extra in total.

For decades, the NHS has failed to invest sufficiently in modern building and equipment. The plan will mean 3,000 GP premises modernised and 500 new one-stop primary care centres; 250 new scanners for cancer and other illnesses; modern information technology systems in every hospital and GP surgery; 100 new hospital schemes in the next 10 years; and 7,000 more hospital beds in hospitals and intermediate care, including the first increase in general and acute hospital beds in 30 years. That is only possible because we are making this historic investment in our NHS.

Caring better for NHS staff will mean better care for NHS patients. That is why the plan sets out new facilities for staff, starting with 100 on-site nurseries and money for individual training for all staff--not just the professions, but the support staff as well. Our task is to tackle not simply years of underfunding, but years of low morale.

We know that money alone, however, is not the solution. Over the past few months, I and my right hon. Friend the Secretary of State for Health--to whose work in drawing up the plan I pay tribute today--have had scores of meetings with NHS staff and professionals, visited hospitals and GPs, and spoken to providers and users of the NHS. Because the issue of funding has been alleviated, at long last, people have been able to lift their heads and look at the system in which they operate.

The NHS staff are magnificent. They are the greatest asset that the health service has. They are indeed the basis of the trust that the British people put in the NHS, but,

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in truth, they have been, and often still are, working flat out in a system that is still organised as it was in the 1940s. Today, patients and staff alike expect and demand a wholly different type of service for the new age in which we live.

What is extraordinary is that this is the first time that any Government have looked long and hard at all aspects of the NHS: the absurd demarcations between staff that keep patients waiting; the splits between social services and the NHS that make life misery for many elderly people; the consultants' contracts, largely unchanged since 1948, the issue of private practice and NHS work left unresolved; GPs' contracts being based too much on quantity, not quality; and a standoff between the private sector and the health service that is not in the interests of NHS patients--all difficult issues, all a relic from 1948, all addressed in this plan today.

Each of those issues is faced up to and fundamental reform proposed. The aim is clear: to redesign the health service system around the needs of the individual patient.

First, the role of nurses will be radically enlarged and old barriers to modern working removed. A qualified nurse has had at least three years training. It is wrong that, in many places, nurses are unable to make and to receive referrals, to admit and to discharge patients, to order tests, to run clinics and to prescribe drugs. Those old rules will be swept aside and nurses in every hospital will have that opportunity.

Secondly, let me say something about general practitioners. The vast majority do a superb job, as we all know. They are highly respected, and rightly so. We should never allow the publicity given to the few exceptions to undermine the excellence of GPs' reputation. But--again--their contract is outdated and inflexible. GPs can do more--they could even do some of the work that is currently undertaken by consultants--and they should have far more freedom in respect of how they use the money that they have.

We aim over time, without compulsion but with clear incentives, to move GPs to a new system of contractual arrangements. The personal medical service contract will reward doctors on the basis of quality of care as well as on the basis of patient numbers, and will give doctors far more flexibility to innovate and change. [Interruption.] This will not be the old two-tier system.

There will also be more salaried doctors. Taken together, the changes I have announced will be the most significant changes in the way in which GPs operate since 1948, and will literally be able to transform primary health care in this country.

Consultants do an extraordinary job for the national health service. Their expertise and immense skill are key to its future. That is why we are increasing consultant numbers by a third, and giving leading clinicians a greater role in the setting of national standards. Again, however, the consultant contract has remained largely unchanged since 1948, and, although most consultants work extremely hard for the health service beyond their contractual commitments, there is no proper management of their time. We will ensure that all consultants have proper job plans setting out their key objectives, tasks and responsibilities; that has never happened before. Moreover, consultants' performance will be regularly reviewed.

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Above all, however, we want to reward most those who make the most commitment to the national health service. First, to encourage high standards of performance and use of the new national service frameworks, we are giving consultants, along with others, access to part of the new £500 million performance fund, which will give extra money to those who meet the highest standards of service. Secondly, we will merge the existing distinction awards and discretionary points schemes, and increase their funding. By 2004 we will increase the number of consultants receiving superannuable bonus from less than 50 per cent.--the present number--to about two thirds, and will double the proportion of consultants who receive annual bonuses of £5,000 or more.

Thirdly, we are offering a deal to new consultants. From now on, once a person is newly qualified, that person will be contracted to work exclusively for the NHS for the first few years of his or her service.

Again, those will be the most substantial changes to consultant contracts since 1948.

The next major reform is to remedy the extraordinary situation that means that at any one time thousands of older people are in the wrong place for their needs. They are stuck in hospital, when they could be cared for better in their own homes. For the first time, social services and the NHS will, in every area, use pooled budgets and new arrangements that will ensure that they work together for the good of the patient. When local councils and primary care trusts want to go further and merge into a single organisation, we will enable them to do so by creating new care trusts delivering one-stop care with a unified budget. When partnerships persistently fail to deliver, we will require local health and social services to join in a new care trust.

I thank Sir Stewart Sutherland, who chaired the royal commission on long-term care, and the other members of the commission. A full response is published alongside the health plan.

Today, we are correcting a major injustice in the system. The NHS provides nursing care free of charge for people living in their own home or in hospital. Until now, however, nursing provided in a nursing home has been charged for. That will now change. From October 2001, subject to parliamentary approval, nursing care in nursing homes will be treated as nursing care elsewhere in the NHS--free at the point of use.

Additionally, we are investing in a major expansion of intermediate care prevention and rehabilitation services for the elderly: by 2004, spending on those new facilities will increase to £900 million per year. We shall also, as the commission proposed, expand respite care, benefiting 75,000 carers and those for whom they care.

Taken together, the package amounts to an extra £1.4 billion per year for older people. That is more investment than the royal commission itself called for.

Next, there is a series of reforms aimed at preventing ill health and improving the nation's health, including measures to reduce smoking and improve diet. Central to that are measures to reduce health inequalities. The truth is that the gaps between the health of the poorest and the health of the better off in our society are completely unacceptable in modern Britain. Moreover, it is children who pay the biggest price for those gaps. That is why programmes such as sure start, enhanced maternity grants,

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increased child benefit and the new deal for communities are so vital, and why we should fight so hard to protect them against those who would abolish them.

Next, we shall reform treatment of the most serious illnesses, such as cancer and heart disease. Until now, there have been no national standards for treatment of those illnesses, and the availability of treatment has often been patchy--some people get drugs, others do not; some people are seen quickly, others are not. For each of the main conditions, therefore, there will be a national framework of standards specifying minimum standards of access and the care to which patients are entitled.

The framework for cancer, for example, will entail maximum waiting times that cover not only referral to diagnosis, but diagnosis to treatment; a big expansion in cancer screening and cancer specialists; and an end to the postcode lottery in prescribing cancer drugs. Additionally, 400,000 patients will benefit every year from new equipment for diagnosing and treating cancer. The framework for coronary heart disease will entail an extra £230 million per year by 2004; a 50 per cent. increase in cardiologists; and shorter waits for heart operations.

The national service frameworks will reflect a fundamental change in the relationship between central Government and the local NHS. The centre will do what it must do: set standards, monitor performance, support modernisation, put in place a proper system of inspection, and, when necessary, correct failure. The new Commission for Health Improvement will inspect and report on hospitals, primary care groups and primary care trusts. That information--like information on schools from the Office for Standards in Education--will be available to the public.

If necessary, the worst performing trusts will have new management put in. In future, the 3,000 non-executive board members of trusts and health authorities will be appointed not by the Secretary of State, but by an independent appointments commission. There will also be a new independent panel to advise the Secretary of State on proposed reorganisations of local hospitals and health services.

There will be maximum devolution of power to local health professionals. Over time, primary care groups will move to being primary care trusts, offering minor surgery, physiotherapy, diagnostic tests, and even minor operations in the local primary care centre. For all PCTs, health authorities and hospital trusts, there will be a new system of what is called "earned autonomy" that will radically reduce the amount of central intervention where performance is high. Patients put their trust in front-line doctors, and so do we.

The best performers will be given greater freedom and flexibility, and all will have access to additional funds tied to clear outcomes in performance. That will include a new framework--a concordat--with the private sector. There should be, and will be, no barrier to partnership with the private sector where appropriate--as the private finance initiative hospital building programme has shown. Where the facilities of the private sector can improve care or help to fill gaps in capacity, we should use it, but let me make one thing clear: we will never permit people to be forced out of the health service for non-urgent care. That would destroy the national health service. Where the private sector is used, it will be fully within the national health service, free at the point of use to the patient.

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We also examined in detail alternative methods of funding the health service. We concluded that the proposals of some to expand health care through tax incentives for private health insurance were massively inefficient and would take vital resources out of front-line national health service care; and that moving entirely to a continental European type of social insurance system, while less inequitable than many other suggested alternatives, would cost an extra £1,000 to £1,500 per employee per annum. We also estimated that, through the health service, administrative costs are hugely reduced compared with other systems. We were therefore confirmed in our view that what the national health service required was not dismantling but modernisation.

At the heart of the reforms is the idea of redesigning the system round the patient. Too often, whatever the quality of actual care, the patient is catered for in dirty wards on rundown premises, with standards of food and basic amenities far below what would be tolerable in other services. Part of the reforms is designed to remedy that. Clean wards and better hospital food will become central to trusts' work, with new resources to back it up.

That will get under way now. By 2002, 95 per cent. of mixed sex wards will have gone. NHS Direct will be available in all parts of the country. In time, we aim to have the ability to link all parts of the system through technology, so that one call will put the patient immediately through to the right place.

By 2005, booked appointments will have taken the place of the old waiting lists. As a first step, by April 2001, all hospitals will be using booking for two of their major conditions. By 2003-04, two thirds of all appointments must be pre-booked.

By 2004, there will have been an end to long waits in accident and emergency; people will get an appointment with a GP within a maximum of 48 hours; and, if an operation is cancelled on the day it is due to take place, other than for medical reasons, patients will get another one within 28 days or have their treatment funded somewhere else. Patients will also have more say and more choice, with a patient advocate and forum in every hospital to give them immediate help with sorting out their complaints, and a voice in how the hospital is run.

Over time, these changes, plus the money and the staff, will allow waiting times to come down substantially. By 2005, the maximum waiting time for an out-patient appointment will be three months, and for an in-patient appointment six months rather than the present 18, with urgent cases being seen the most rapidly.

Average waiting times will, as a result, also come down: from seven to five weeks for out-patients and from three months to seven weeks for operations. There will be reduced waiting times for all conditions--not just some--and our eventual objective, provided that we recruit the staff and make these reforms, is to get the maximum waiting time for any stage of treatment down to three months by the end of 2008.

There are many other proposals for change set out in the plan. It will mean, over time, radical change in the health service, but I emphasise to the country that it will take time. Some changes will be fast, but others are crucially dependent on new investment in staff and facilities coming through. Staff are crucial to this process. Uniquely, the principles that underpin this plan command

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the wide support of professions and staff across the NHS, as will be seen from the signatures to the principles at the start of the plan.

There is another cause for optimism: at every level of the health service, there are examples already of where change and reform have made a difference. We know that the plan is achievable because somewhere in the health service it is already being achieved. The challenge has been to remove the outdated practices and perverse incentives that have prevented the best from becoming the norm. I make it clear to all NHS staff: we will carry on with the same system of co-operative working and partnership that has characterised the past four months. This is the beginning, not the end, of that process.

The challenge is to make the NHS once again the health care system that the world most envies. Now, with the money going in, the reforms can follow so that we can proclaim loud and clear that the idea of decent health care based not on wealth or position, but on need and suffering, is not an old-fashioned principle that has had its day; it is, rather, a timeless principle that this generation has found the courage to reinvigorate for the modern world. That is what we set out in the plan, and I commend it to the House.

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