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Mr. Milburn: My hon. Friend is right on both counts. All parts of the primary care system require improvements in IT infrastructure, which has suffered from under- investment. Parts of the health authority allocations are specifically for improved IT in GP surgeries and hospitals.
My hon. Friend will be aware from the NHS plan that we want primary care to involve GP surgeries and health care centres in establishing at-risk registers to identify those patients who have had, or are liable to have, a heart problem. As he knows, some fairly simple, cost-effective treatments can be made available to such patients. They are far more effective and better than people having a heart attack before going to hospital for a serious operation.
Mr. Peter Lilley (Hitchin and Harpenden): Can the Secretary of State explain why, despite Labour's promises, mortality rates--the number of people dying within 30 days of emergency treatment--in four out of five hospitals surrounding my constituency are no lower than during the last year of the previous Conservative Government? Will he also confirm the National Audit Office figures that showed that nearly one in 10 NHS beds is occupied by a person who acquired his infection or complication while in hospital, as the hon. Member for Newport, West (Mr. Flynn) suggested? If the right hon. Gentleman could solve that problem, would that not relieve human suffering and release far more resources than he announced today?
Mr. Milburn: I am grateful--just about--to the right hon. Gentleman for his comments. For the first time, we
have infection control teams in hospitals up and down the country. We established them, not the previous Government. Frankly, is not the idea that hospital- acquired infection suddenly broke out on 1 May 1997 rather laughable?
Mrs. Anne Campbell (Cambridge): I warmly congratulate my right hon. Friend on his statement and on yesterday's announcement of £22 million for Addenbrooke's hospital, which will help my constituents. Does he agree that the 32 extra beds that that £22 million will achieve will mean shorter waiting times, and that that would be put at risk if a Tory Government were ever re-elected because they prefer tax perks for those with private medical insurance?
Mr. Milburn: My hon. Friend is right on both counts. We are now in a position to reverse a decline in the number of acute and general beds in hospitals, which has been occurring for many--perhaps 30 or 40--years. As I have told the House before, my view is that we must increase the number of hospital beds and beds in the whole care system if we are to provide the quality of care and the speed of response that patients rightly expect nowadays. She rightly said that all that investment would be put at risk thanks to the cuts guarantee that the Conservative party has, in effect, now published. It would take £9 million from every health authority in the land. Conservatives must explain that to their constituents; I am sure that my hon. Friend will explain it to hers.
Dr. Peter Brand (Isle of Wight): I should like an assurance from the Secretary of State that all the money in the performance fund will be spent. Are there any moneys outstanding in this year's performance fund allocation? Does he recognise that some health authorities cannot perform because they cannot attract the necessary staff and have to rely on extremely expensive agency locums? That is a tremendous disadvantage to health authorities, such as the Isle of Wight.
Mr. Milburn: The Isle of Wight will do rather well as a consequence of some of the changes that I have made today. The hon. Gentleman lives in hope; I live in hope that he will see the light eventually. The performance fund will be fully spent. It is important to make it clear that the idea is that each and every part of the local health service will get its fair share of the performance fund. However, the poorer performers will inevitably have strings attached--of course they will; that must be right. If they have not come up to scratch, most right hon. and hon. Members would be pretty wary of spewing yet more resources into them without conditions being applied.
There are problems with agency nurses, but the hon. Gentleman knows that, on Friday, the Prime Minister announced our proposals to ensure that the NHS gets to grips better with precisely those problems, so that we improve the quality of care for patients and the value for money for taxpayers.
Mrs. Louise Ellman (Liverpool, Riverside): How much has been allocated to addressing health inequalities in Liverpool? My constituency has been identified as the second poorest area of the country and the one suffering the worst ill health. How will my right hon. Friend ensure that the money allocated is targeted at the areas of
need already identified in Liverpool by the performance indicators published earlier this year, so that it specifically addresses the issues of too few general practitioners, the shortage of staff to undertake cancer screening and the high levels of heart disease and emergency hospital admissions?
Mr. Milburn: I am grateful to my hon. Friend for her comments. Liverpool will receive an extra £4.3 million as a health inequality adjustment within its health authority allocation this year, precisely to take account of some of the very real problems that she describes. However, it is not just a matter of getting the money into those areas; we must also ensure that we get the services and the staff into the inner cities. She is aware that because of how we have distributed GPs around the country in the past, we have not always met need in primary care in the way in which we should. That is precisely why we are rolling out a big expansion in the number of personal medical services GPs, and I expect that next year a substantial proportion of those will go into precisely the areas that she describes, where they are most needed.
Mr. Michael Howard (Folkestone and Hythe): I welcome the emphasis that the Secretary of State places on the treatment of heart disease and on dealing with waiting times. Is he aware that, in east Kent in July, 108 people had been waiting more than three months for heart surgery--the comparable figure for March 1997, about which he was so scathing, was 63--and that 207 people had been waiting more than 13 weeks to see a cardiologist--the comparable figure for March 1997 being 40? Is he not thoroughly ashamed of those figures? What assurances can he give my constituents that things will not get even worse this winter?
Mr. Milburn: As the right hon. and learned Gentleman is aware, for the first time the Government have made available earmarked funding precisely to tackle some of the problems in heart surgery rates that we inherited. The previous Government did not make a penny piece available for earmarked heart surgery; we have done so. During the next few years, there will be 3,000 extra heart operations, a further 3,000 extra heart operations, and, over time, as we expand the number of heart surgeons, waiting times for treatment will come down not just in his area, but throughout the country.
Ms Hazel Blears (Salford): My right hon. Friend's statement will be welcomed by people in Salford. It is real evidence of the Government's commitment, and indeed my right hon. Friend's personal commitment, to tackling health inequality. I find the Opposition's last-minute, deathbed conversion to redistribution singularly unconvincing, but we wait to see the evidence of what they have said.
I know that my right hon. Friend recognises that the causes of inequality are complex and that the NHS acting alone cannot resolve all the problems. Will he ensure that the extra investment is worked on with partners in local government and in the voluntary sector to ensure that we get added value from the extra resources that we put in, and that we monitor closely the outcomes that we achieve? The extra money must make a real difference to our communities.
Mr. Milburn: I very much agree with my hon. Friend. As she recalls, a year or so ago I visited parts of her
constituency where there is deprivation and associated pockets of ill health. She is right that the job of tackling health inequalities and improving life chances for people is not just the job of the NHS--it must be done in concert with local government, local organisations and, most important, local communities. That is precisely what we are seeking to do through the local strategic partnerships that the Government are seeking to create.
Mr. John M. Taylor (Solihull): Will the Secretary of State confirm that there may be many instances when it makes sense for the NHS to contract services to the private health sector, not least because that sector has lower unit costs? If he has come to that conclusion and is prepared to do that, may I congratulate him?
Mr. Milburn: I am not sure about the issue of unit costs; that will have to be hammered out on the ground between the local health service and the local private sector provider.
As I have made clear before in the House, I have no problem with the NHS contracting with private sector providers to ensure that NHS patients receive treatment for free and in as timely a way as possible. However, there are two important caveats: we must be assured that we are getting the highest standards of care for patients and the best value for money for taxpayers.
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