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Mr. John Maples (Stratford-on-Avon): One of the things that I believe bothers all our constituents is the length of time that they sometimes have to wait to get an out-patient appointment with a consultant. The Prime Minister announced that he wanted that maximum wait to be reduced to three months. That would be a welcome, although not desperately ambitious, target. Can he explain why it will take him until 2008 to achieve it?

The Prime Minister: Waiting times will start to come down a long time before that, and three months will be the maximum wait; the average will be far less. The explanation for which the hon. Gentleman asked is a perfectly simple one. For years, there have been insufficient staff and consultants in the health service. We have to expand the numbers, but that will take time. However, the other thing that we can do in the meantime is to change the system.

Consultants to whom I spoke over the past few months said that up to 40 per cent. of their time was spent unnecessarily seeing patients, because some of that work could be done by either GPs or nurses, or, in the case of back injuries and so on, patients could be seen by other qualified professionals. So, lots of changes in the system are necessary, but it will take time to get there. The changes will be seen almost immediately, but it will take some years to get the system fully sorted out.

Mr. Win Griffiths (Bridgend): This is a very welcome statement and my hon. Friend the Member for Bolsover (Mr. Skinner) was absolutely right in everything that he said. Will my right hon. Friend confirm that the figures that he gave on consultants and other NHS staff were related specifically to England? If that is the case, can he confirm that it means that in Wales there will be between 375 and 400 extra consultants, to bring the health service up to a standard of which the Welsh people can be very proud?

The Prime Minister: Perhaps I should have pointed out that the Joint Ministerial Committee has met with people from the devolved Administrations of the United Kingdom, and it is of course for them to decide how they make progress, but I understand that they will all be publishing, in the not-too-distant future, their own version of how this money can be used and what they can get for it.

Dr. Evan Harris (Oxford, West and Abingdon): Is the Prime Minister aware that early this week, the chief executive of the Oxford Radcliffe said that he was ashamed of the severe bed crisis at the Radcliffe? Of course, the chief executive has not had the opportunity to put in early extra resources. Will the right hon. Gentleman

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apologise for his Government's decision to opt for tax cuts in the first two years rather than investment in the health service?

Until that money, which is much welcomed, comes through, there will be a need to recruit nurses and doctors. Will the right hon. Gentleman promise not to pillage developing countries for their trained doctors and nurses?

The Prime Minister: First, we are putting in more beds. Secondly, the criticism of us in our first two years, especially from the Conservative party, has often been that we were too hard with people in clearing the financial deficit and so on, but we had to achieve a balance and I think that we got it right.

As for the hon. Gentleman's last point--an important point--we do not intend to try to take doctors from developing countries where they are urgently needed, but we will, where necessary for short-term reasons, recruit doctors from developed countries.

Mrs. Rosemary McKenna (Cumbernauld and Kilsyth): I welcome the statement. In all plans, the devil is always in the detail. However, I think that, for the very first time, we have a Government who are committed to a holistic approach to health. Allied to other policies, that will make a fantastic difference to those people who are unable to afford health care of any other kind.

Can my right hon. Friend say how this will be dealt with in the devolved Administrations, and Scotland in particular, and will it be discussed in the Joint Ministerial Committee?

The Prime Minister: It will be discussed in the Joint Ministerial Committee. Obviously, it is for the devolved Administrations to decide how best to make progress. There will be changes; they will want to do it in their own way, but I think that they broadly accept the basic outlines of what we are doing.

Mr. David Curry (Skipton and Ripon): The Prime Minister's statement raises the prospect of really large consortiums spanning health and social services. Where does he expect the management to come from for those? How will he maintain accountability for those services if social services then effectively become managed from the health side of that equation? Is he aware that when elderly people put themselves in residential care but run out of money to pay for it, they become the responsibility of the local authority, which is not funded for those people? That is a cause of bed blocking, and if the Prime Minister does not address it he will not tackle one of the big dislocations between health and social services.

The Prime Minister: It is for that reason that we are putting more money into social services as well. I agree that we need to deal with that problem.

In relation to the consortiums that will run health services locally, we have to develop a cadre of managers to do that, but the primary health care trusts that I have seen in action so far give us significant cause for optimism. They have far greater flexibility; they are able to span across primary care groups; they are able, for example, to have their own physiotherapists; they are able to make far better use of practice nurses; and they get economies of scale. That will mean that we have to

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develop, over time--a specific centre is being established as part of the plan--a cadre of leaders, managers and executives who can do that. That gives us the best of maximum devolution without the difficulty of the old internal market system, namely, that there was too much competition between local bodies.

Mr. Kevin Barron (Rother Valley): The announcement today that the national health service will be more patient focused should be warmly welcomed by everyone in the House and outside. My right hon. Friend has just made an announcement about the next five years' investment in the national health service. Will he confirm that that will be invested in the national health service and not elsewhere within health care in this country?

The Prime Minister: Yes, that is indeed an investment in the national health service.

Mr. Peter Brooke (Cities of London and Westminster): In the light of today's announcement, when that notable health care authority Brian Abel-Smith advised the Labour party that individual GP fundholding was a good initiative that should be made universal, why did the Government interpret and implement that advice by making fundholding collective rather than individual?

The Prime Minister: We received advice from many other people that it was not such a good idea. That brings me back to what was said earlier about patient choice. For doctors who were not fundholders, there was a huge restriction of choice. The benefit of an internal market was the devolution of power downwards, but the problem was the competition and the two-tier system that arose. Through primary care groups and trusts, we have tried to extend the notion of local devolution, but on a co-operative rather than a competitive basis.

Dr. Howard Stoate (Dartford): Does my right hon. Friend believe that public funds should be used only for the benefit of NHS patients? If so, is that view shared by the British Medical Association, the Royal Colleges of Nursing, of Physicians, of Surgeons and of General Practitioners, the NHS Confederation and others?

The Prime Minister: It is, indeed, one of the principles that all the bodies to which my hon. Friend refers have signed up. It is an important principle. People are perfectly free to take out private medical insurance, but it should not be subsidised by the taxpayer.

Mr. David Tredinnick (Bosworth): The Prime Minister talked about alternative funding, but said nothing about alternative and complementary medicine. Given that a quarter of the population have used some form of complementary medicine such as homeopathy, herbal medicine or channelled energy, what is he doing to make sure that such treatments are available in the NHS? Can he confirm that he and his immediate family have at some stage used some forms of complementary and alternative medicine?

The Prime Minister: I am not going to go into the latter point. On the former point, certain forms of complementary medicine are already available on the NHS. The plan does not specifically deal with the issue.

Ann Clwyd (Cynon Valley): I am the only Member who was a member of the royal commission on the NHS,

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which was set up by a Labour Government, but unfortunately reported to a Tory Government. Its recommendations were ignored until this day. For those members who worked hard during those three years, it will certainly be a vindication of our efforts to find so many of our recommendations implemented in the plan.

My right hon. Friend was right to criticise the Leader of the Opposition, who left the health service in Wales in a total mess. In constituencies such as mine, we have a third-world health service as a result. I am certain that if Nye Bevan were alive, he would be standing up and cheering on this day.

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