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Mr. Nicholas Winterton (Macclesfield): I welcome the Prime Minister's statement about the NHS for the future and the plan that he has put to the House. I am sure that he would accept from me--my credentials in support of the health service are, I think, well known--that the proof of the pudding is in the eating. Clearly, people will want to see how the reforms and the plan unwind. Will he assure me and the House that doctors and consultants will have total clinical freedom and that the pressures of bureaucracy put on them by central Government in respect of waiting lists will be removed?

I warmly welcome the additional responsibilities that the right hon. Gentleman is giving to the nursing profession, which could save the health service a great deal of money. Please will he be a little more forthcoming, however, about what is nursing and what is social care when dealing with long-term care for the elderly? To my mind, that matter is critical. Does he not feel that he is putting a great deal of pressure on the nurses who have to make that decision?

The Prime Minister: Probably, it is best that nurses make that decision, as they will be able to assess what care they, as nurses, need to provide. It is probably better to leave that decision to them, obviously with some flexibility, rather than to draw up such tight rules that they would cause more trouble rather than help.

As for consultants, of course they will have the power to determine priority cases. I make no apology for saying, however, that we are trying to get as many consultants as possible to consider new and different ways of working. Every stage of the health service that I have seen in my visits of the past few months convinces me that, by fairly simple changes that are not rocket science, the way in which patients are treated--from the time they first see their GP to the time that they have their operation--could be hugely simplified. Basic protocols and frameworks can be drawn up to allow that to happen.

Obviously, it must be for individual consultants to decide these matters, but it is frustrating when one sees that some practices in the health service have literally abolished waiting lists and times, but that those practices are not universal within the service. That is what we will try to do through the new performance fund. Certainly, I pay tribute to the hon. Gentleman's own commitment to the health service.

Mr. Dennis Skinner (Bolsover): Does my right hon. Friend appreciate that while he, our right hon. Friend the Secretary of State for Health and others have been touring hospitals to devise this plan, many people have been attending hospital because they had to? During the past 15 months, I have been on a steep learning curve in the NHS. Most of those with whom I sat in queues during those months would give my right hon. Friend seven or even eight out of 10 for today's announcement. By any stretch of the imagination, this is a big day not only for the NHS but, more important, for all those people who have had to use it over the years. People left hospital searching for the blue in the sky--sometimes they never saw it. Today's announcement means that a lot more

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people will leave with a smile on their faces, in the knowledge that the health service has been improved--not perfection, but made one hell of a sight better.

The Prime Minister: I thank my hon. Friend. I hope that he is right. It will take time, but I am sure that we can do it.

Mr. Tim Boswell (Daventry): As one TB to another, perhaps we can agree to overlook the adviser's memo that suggested that the Prime Minister had failed on the health service.

Will the right hon. Gentleman explain to my constituents how his announcement today will bring them a better health service when, during the past three years, successive announcements made by various Ministers have achieved a local situation in which waiting lists are at best static, the waiting list to get on the waiting list has doubled and the district general hospital is full at the height of the summer?

The Prime Minister: I can explain how it can become better. No doubt, the hon. Gentleman needs in his constituency more hospital staff and better facilities. That is precisely what this investment gives us. If we achieve better working between social services, primary care services and the hospital service, that too will improve the situation. I have not come to the House today to say that everything in the health service is perfect; of course it is not--otherwise we would not need this plan. I hope that we can work to achieve the changes.

I point out to the hon. Gentleman--although I am not sure whether he is too much in agreement with much that is said by Opposition Front-Bench Members--that if he considers--[Interruption.] I am sorry, I may have dealt the hon. Gentleman a career blow. I did not mean to do that; I am sure that he is wholly in agreement with Opposition Front-Bench Members. [Hon. Members: "He is a Front-Bench Member."] That is even better--I am afraid I missed that.

If the hon. Gentleman analyses what the Conservatives have promised financially, there is a big division--that is a real issue for Opposition Members. With the strength of the economy, we can either put more money into our essential public services or not. His party have chosen not to do so. My right hon. Friend the Chancellor announced additional spending of 3.3 per cent. The Leader of the Opposition and the shadow Chancellor said that it should be less than 2.25 per cent. That is a fact. On my arithmetic, that means that one third comes off the spending figure. If the Conservatives are going to take a third off health spending, heaven help the law and order, transport and education services.

Ms Joan Walley (Stoke-on-Trent, North): I thank my right hon. Friend the Prime Minister and the health team for all their hard work and leadership in dealing with the legacy of underfunding from the Tory years. In Staffordshire, we have already shown that, with modernisation, we can improve ambulance services. With the extra 6 per cent., we can deal with the existing underfunding.

My constituents are right behind my right hon. Friend in wanting something to be done about long-term care beds and community care for the elderly. Will he

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personally take an interest in the Edwards report and ensure that there is a pilot project in north Staffordshire to address funding in long-stay beds and social services with the new pooled budgets?

The Prime Minister: On the point about long-stay beds and community care, the additional money that we have announced today should help in part.

As for what has happened already in the health service, it is important to recognise that the position in the health service varies in different parts of the country; however, by the end of this year, for example, all the accident and emergency departments that need modernising will have been modernised, and that will make a significant difference. Therefore, I think that the money is already slowly beginning to have an effect, but obviously the additional funds cannot come in over a period of years.

Mr. Andrew Rowe (Faversham and Mid-Kent): First, everyone would agree that improvements in the use of social services are desirable, but is the Prime Minister comfortable with the proposition that, inevitably, under his plans social services will revert to the kind of medical model that was deserted nearly 50 years ago? Secondly, is the right hon. Gentleman comfortable with the emasculation of the local authorities, which is happening so fast under his Government?

The Prime Minister: That is a new tune from the Conservative party. I do not accept the proposition on the social services and medical model, but certainly, judging by the work that I saw and the people to whom I spoke in the health service, one of the main problems is the lack of proper co-ordination between social services and local hospitals and primary care groups. As a result, very often large numbers of people--particularly elderly people--end up in the wrong place in the system. Having a pooled budget enables those bodies to look at these things together, and obviously it is then up to them to decide whether they want to go for a local care trust, which would mean a unified budget.

In some parts of the country people already have a pooled budget, and that has had a significantly better impact. Indeed, I think that in different parts of the United Kingdom, such as Northern Ireland, that has been a tradition over many years. The absence of proper co-ordination between the two parts of the service has caused distress to a great many patients over the past few years.

Angela Smith (Basildon): Is my right hon. Friend aware that one of the pilots for testing the system of pre-booked appointments was actually at Basildon hospital in my constituency? Is he further aware that through the efforts of the staff at the hospital, who were pleased to change the way in which they worked, and who, through their effort and commitment, have really made the system succeed, patients all over the country have reaped the rewards of that? The response that I am getting is excellent. Will my right hon. Friend congratulate those members of staff?

The Prime Minister: A former chief executive of the hospital is playing a leading role in that project. The importance of the booked appointments system and the fact that it is already in use in certain parts of the country

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show again how things can be done. The importance of that system is that it literally ends the whole concept of waiting. In order to get there, of course, there must be a sufficiently low maximum waiting time--the system of booked appointments cannot work if waiting times are very extended. However, the system is working in certain parts of the country and the plan sets out a detailed list of ways in which it can be improved.

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