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Rev. Martin Smyth (Belfast, South): I am aware of an increase in the number of nurses. Many of them are outside the national health service. Is the Minister saying that there is a definite increase in the number actually in the national health service?

Mr. Milburn: Yes; that is precisely what I am saying. The number working in the national health service--that is, those recruited minus those who have left--is increasing. There are more nurses working in the national health service than there were just a year ago: 6,000 more than in December last year, and 16,000 more since the general election.

That is not to say that there are not parts of the country, and very many hospitals and parts of our community services, that still have problems recruiting nurses; they

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certainly do have such problems. However, I am sure that the hon. Gentleman does not want to give the impression that those on the Opposition Front Bench seek to give. He must not give the impression that the national health service is not moving forward--it is. Just because we have not solved every problem does not mean that we are not solving problems along the way.

Mr. Tim Loughton (East Worthing and Shoreham): Let me give the Secretary of State an example of where that is not happening. When I became a Member of Parliament, the Worthing and Southlands hospitals trust had some 75 nursing vacancies. Three and a half years later, having gone to recruit in Australia, South Africa and--as we speak--the Philippines, that hospitals trust still has 75-odd nursing vacancies. Why is the improvement not happening in my constituency?

Mr. Milburn: There is a clear explanation for the changes in nurse vacancies: the NHS is in a period of expansion, so trust hospitals are advertising for more nurses. That is the right thing to do. We are not in a period of contraction, such as we saw when the previous Government were in office. In every part of the country we are making progress, thanks to the investment that we are making and the measures that we are taking to improve nurse numbers in the NHS.

The same is true for bed shortages. For 40 years, acute and general beds in the NHS were cut. In their last 10 years in office, the Tories cut 40,000 beds alone. Today the number of hospital beds is rising again. In the last year, there has been an increase of 1,350 general and acute NHS beds in England. The long decline in bed numbers is finally beginning to be reversed.

I know that Opposition Members are keen to give the impression that the NHS is either totally broken or totally mended. It is neither. The NHS today is a service in transition. The internal market has gone, more patients are being treated, in-patient and out-patient waiting lists are falling, more heart operations are being performed and cancer waiting times for referral to hospital are coming down. After decades of neglect and, incidentally, a refusal to hypothecate funding for these services, in the next year alone £450 million extra will be invested in cancer and heart care to make services better and faster for patients. The nation's top clinical priorities are the Government's top clinical priorities.

Mr. Bob Blizzard (Waveney): My constituent, Mr. Stephenson of Lowestoft, feels strongly that his wife was badly let down by a particular oncologist who was treating a cancer from which she sadly died. He feels even more badly let down by the General Medical Council because of the way it refused to investigate the matter fully. Does my right hon. Friend agree that across the country there are lots of people like my constituent who have lost confidence in the GMC in this respect and feel that it is not sufficiently independent? How does my right hon. Friend propose to address this problem? Is there anything in the Queen's Speech that will contribute to making doctors more accountable?

Mr. Milburn: Obviously, I am not aware of the circumstances leading to the situation that my hon. Friend describes, so I cannot comment on the individual case. I am sure that the whole House will want to join him in

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passing on our condolences to Mr. Stephenson. When I read in the newspapers about a cancer or a meningitis diagnosis being missed, as can happen in the NHS and in every health care system in the world, it is not because the doctors are not trying or because they are not well trained. They are, but sometimes these diseases are difficult to diagnose. It is important that none of us gives the impression that somehow medicine or clinical science is a perfect science. It is not. It is a human science and, sadly, sometimes things go wrong.

We have to learn the lessons when things go wrong and we have to have a form of professional self-regulation--I support that, although other Members do not, because I think it is the right thing for the medical profession--that is accountable, open and subject to public scrutiny and that commands the confidence of the profession and the public. As my hon. Friend is aware, even now the GMC is discussing proposals for its own reform. That is a matter for the GMC and it will discuss the proposals in the weeks and months that follow. It will be for the Government and, indeed, Parliament to judge whether its proposals are capable precisely of restoring the public confidence that has been damaged by some of these incidents. We shall consider that matter very carefully, and hon. Members on both sides of the House will also wish to do so.

Of course no one denies that there are very real problems in the national health service today--how could there not be after years of neglect and decades of under-investment? It is true that many patients still wait too long for treatment, that more doctors, nurses and beds are still needed and that staff are still under very real pressure, but it is also true that real progress is being made on all those fronts and many more.

The investment and the reforms that we are making will deliver expanded services for patients. During the next few years, there will be 20,000 more nurses; 7,500 more consultants; 2,000 more GPs; 1,000 more medical students, on top the 1,000 already in the pipeline; waits of weeks, not months, for cancer treatment; guarantees for patients on cancelled operations; and maximum waiting times for treatment.

Dr. Peter Brand (Isle of Wight): That is an impressive list of achievements that the right hon. Gentleman wants to put in place in the next few years, but can he tell us how many more cleaners and porters are employed by the NHS as of today? Those people do not take three or six years to train, but we need them.

Mr. Milburn: The first part of that intervention was absolutely brilliant, but the second part flagged slightly. I do not have those figures, but I shall try to let the hon. Gentleman have them. Of course the cleaners, porters, scientists, technicians and all the other members of the health care team play an absolutely crucial role in the NHS, as well as the doctors, nurses and managers. Some of the previous Government's reforms--for example, those on cleaning--have been abject failures. That is precisely why we have got rid of compulsory competitive tendering in the NHS. It failed to keep our hospitals clean and failed to raise standards. In fact, it led to a decline in standards, and not just in hospitals.

The health and social care Bill will take forward the investment that the Government are making in the NHS. Most important, it will take forward the programme of

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reform outlined in the NHS plan. First, the Bill will enact the NHS plan reforms to give greater freedom to the best performing local health services. The principle of earned autonomy will ensure that as modernisation takes hold, so there will be more devolution to the NHS front line. A performance fund of £100 million next year will rise to £500 million by 2004. That decentralisation will complement the decisions that I have already taken to surrender the Secretary of State's powers to make appointments to local health boards and to consider controversial changes to local health services.

Mr. Graham Brady (Altrincham and Sale, West): Is the Secretary of State concerned that eight months after the Commissioner for Public Appointments found that his practice in public appointments in the health service was one of systematic politicisation, she has had to begin further scrutiny of the appointments to primary care trusts that have been made since then? Is that not disgraceful?

Mr. Milburn: The hon. Gentleman has been here a moment or two, so he can presumably confirm what I have just read out to the House: we are giving away precisely those powers to an independent appointments commission, partially because of the concerns that have been raised. That is the right thing to do, and it will happen. It represents massive decentralisation and devolution of power.

Mr. Brady: Will the right hon. Gentleman give way?

Mr. Milburn: No, the hon. Gentleman has had two cracks of the whip on the matter--once with the Leader of the House and now with me. He will fail to be satisfied because he is not getting the answer that he wants, but it is the right answer.

Secondly, the Bill will strengthen the power of patients in the health service. Community health councils were created a quarter of a century ago. Some CHCs have done a good job and some have not, but all are in part appointed by the Department of Health and, indeed, by me as Secretary of State. They are insufficiently independent and lack the democratic legitimacy needed in today's NHS. The Conservatives abolished local democratic scrutiny in 1991, when they purged health authority boards of locally elected people. Today, no part of the NHS is subject to democratic scrutiny, except through Ministers in the House. That must now change.

Under the Bill, the scrutiny of how well local health services serve the local community will be undertaken by those in local government, precisely by those elected by that local community. In addition, patients will be represented for the first time, as of right, on trust boards, and complaints will be dealt with on the spot. Patients' representatives will be able to trigger inspections not just in hospitals but in all parts of the NHS. We want more protections for the patient, more powers for the public, more democracy in the NHS and a bit less bleating from the Conservatives.

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