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The Secretary of State for Health (Mr. Alan Milburn): The NHS plan was formulated with the help of doctors, nurses and managers from hospitals and other parts of the service. It is now being implemented with their help. I have received many representations about the expansion in hospital services set out in the NHS plan. There will be more new hospitals, providing more care to more patients.
Ms Ryan: I thank my right hon. Friend for that answer. However, I want to raise the question of diagnostic and treatment centres for out-patients. Most people who have contact with hospitals are admitted through out-patient departments, and the throughflow of patients causes those departments a lot of wear and tear. The diagnostic and treatment centres represent an important way to keep waiting lists down, but many out-patient departments would benefit from refurbishment.
The Government have rightly concentrated on accident and emergency services, but will my right hon. Friend say how he intends to ensure that out-patient departments reach the standards that out-patients deserve?
Mr. Milburn: That is a very important question. Public and media attention focuses, understandably and inevitably, on in-patient services. There is a very good reason for that, but my hon. Friend is right to say that most people who go to hospital are seen in an out-patient department or in an accident and emergency department.
We have made a start on the problem, in part by investing new resources in out-patient departments. Those new resources were announced some months ago by the Minister of State, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), but we must also change the way in which out-patient services work. We are not talking about rocket science: many leading out-patient departments in the country have been able to reduce waiting times by making better and more flexible use of staff--for example, by ensuring that nurses carry out more roles, and by using physiotherapists rather than orthopaedic consultants to conduct orthopaedic out-patient appointments.
Much can be done in that regard, but the NHS plan contains proposals to reform and expand the national health service, and we must ensure that the good practice of some becomes the best practice of all. We have made a start on that and, although there is a long way to go, I am confident that the commitment of NHS staff to change the way they work and the services they deliver will cause waiting times to fall in every hospital and out-patient department, not just in some.
Mr. Milburn: I would be worried if that was what was happening. However, although I have a great deal of time and respect for the hon. Gentleman, it is clear that he has not read the NHS plan. I shall send him a copy, so that he can ask me a more relevant question next time we have Health questions. The plan sets out the Government's proposals to devolve greater authority and autonomy not only to managers and trust boards in hospitals and elsewhere but, most important of all, to the front-line clinicians--the doctors, nurses and physiotherapists--who, day in and day out, do such brilliant work treating patients.
Does my right hon. Friend agree that the role of the patient--the user of the national health service--lies at the heart of the NHS plan? Patients pay their taxes for the service, and are the best judge of its performance. Will he reassure those who have been active in developing the community health council movement that the plan's proposals will strengthen and give teeth to the concept that patients and users should be right at the heart of the NHS?
Mr. Milburn: That is very much the case. I understand the concerns expressed by hon. Members of all parties about the plan's proposal to abolish community health councils, but many people--in this House and outside it--have long argued that there is a democratic deficit at the heart of the NHS. They have said that we should strengthen rather than weaken the ways in which we monitor what the local health service, which services local communities, is up to.
I support the argument that monitoring and scrutiny arrangements should be put in place. I believe that it is therefore right and proper that we should lodge that power, authority and influence with those who have been directly elected by the local communities. In the end, it must be acknowledged that members of community health councils are not so elected, but that members of local councils are.
The Minister of State, Department of Health (Mr. John Hutton): In 1999-2000, nearly £3.5 billion was spent on mental health services in the NHS. The NHS plan set out further proposals for investment in mental health services, including new teams for crisis support and primary care, and for young people.
Mr. Iain Duncan Smith (Chingford and Woodford Green): (by private notice): To ask the Secretary of State for Defence if he will make a statement about the Government's decision to withdraw the Royal Navy's nuclear-powered hunter-killer submarines from active service.
The Government's decision to withdraw the Royal Navy's nuclear-powered Trafalgar and Swiftsure class hunter-killer submarines from operational service was taken when it became apparent that a flaw in the pipework forming part of the reactor cooling system of HMS Tireless may be generic. As responsible nuclear operators, we decided to carry out a full inspection of all submarines of the strategic submarine nuclear--SSN--flotilla to determine whether this was in fact the case. Some of these submarines were already alongside in refit or undergoing maintenance or repair, and two deployed submarines were recalled.
Initial indications are that the defect may have arisen from the original construction of the submarine and that it is present in other submarines, albeit at an early stage. Let me stress that Vanguard class Trident submarines, which are of a different design, have not been affected.
Until the inspection programme is completed, it is not possible to finalise the repair programme or to quantify the operational implications. The repair is not complex in engineering terms, but, because of the exacting tolerances required for nuclear engineering, it may take some months for submarines to be repaired where this is necessary. The inspection regime and subsequent repair programme will clearly have an impact on our operational programme, although every effort will be made to mitigate this by using other assets and by building on the already close links that exist between the United Kingdom and United States submarine services. Appropriate measures will be taken to protect the deterrent.
I wish to make it clear that at no time has there been any risk to the crew or general public. Safety must take precedence over operational requirements in peacetime, and no submarine will go to sea unless it is safe to do so. Every effort is being made to bring the submarines back into operational service as soon as possible.