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Mr. Roger Gale (North Thanet): Will the Secretary of State give way?

Mr. Milburn: I will in a moment. I have already given way two or three times.

Cancer and cardiac services that had been shamefully neglected are now receiving the investment that they need: they will receive an extra £450 million in the next year alone. Nurse numbers, cut in the 1990s, have risen by 16,000 under this Government.

Mr. Gale: Given his extravagant tirade of abuse against the last Government and his equally extravagant claims for the present Government, can the Secretary of State explain why the private nursing and private residential care sectors are in almost as much despair as farmers? Can he explain why nursing homes in east Kent are closing at a rate of almost one a week? Can he explain why we have lost more than 200 beds since April? Can he explain why hospital beds are being blocked by patients who should not be there, and why operations--although he claims that the situation is improving--are being cancelled daily?

Mr. Milburn: The hon. Gentleman asks for an explanation of what is happening in areas including his own. As he will know, it is true that some nursing homes are closing--[Interruption.] Of course that is true, and of course some residential homes are closing as well, largely because of changes in property values in the hon. Gentleman's area.

Those nursing home closures, however--and the reduction in the number of beds--have been more than compensated for by the extra money that we have invested through our social services spending. The question for the hon. Gentleman, and for the Opposition health spokesman, the hon. Member for Woodspring (Dr. Fox), is this: if the Conservative party is so concerned about closures of care homes and bed blocking in hospitals, will it now commit itself to matching our increases in social services expenditure? That is a simple question, requiring a yes or a no.

Mr. Stephen Day (Cheadle): Perhaps the Secretary of State can answer my question--that is what he is here for. He constantly tells the House of the "neglect" of the NHS that took place during the 18 years when the Tories were running it. The NHS, incidentally, was safer for longer in our hands than under Labour: the Tory party has run it for more years than Labour ever has. Does the right hon. Gentleman accept that there was a 70 per cent. real-terms

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increase in the NHS budget between the election of a Conservative Government in 1979 and the regrettable election of his party in 1997?

Mr. Milburn: If I were the hon. Gentleman, I really would not start giving facts and figures about investment in the NHS. For nearly 20 years, the Conservatives increased NHS spending by about 3 per cent. in real terms. That was not enough to enable the NHS to keep pace with changes in technology and treatment, let alone modernise services for patients. It left the NHS in the state in which it is today. Hon. Members on both sides of the House acknowledge that there are too few beds, too few nurses and too few doctors, that not enough patients are being treated, and that there is not enough investment in cancer and cardiac equipment. Over five years, we are doubling that investment.

If I were the hon. Gentleman, I would look at what the Conservative Government did in the last Parliament. In their last year in office they cut NHS expenditure, cut capital budgets, failed to invest, and cut the number of nurse training places. A little less bleating from the Conservatives would not come amiss.

Today, the NHS is a service in transition. It is true that too many patients still wait too long for treatment, and it is true that more staff are still needed. There is a long way to go, but progress is taking hold. None of that happened by chance; it happened because of the choices that the Government made, and they were the right choices for Britain. We chose to get the public finances back in order to give the country economic stability after years of instability. A strong and growing economy is now providing the foundations for strong and growing public services, not just for one year--it is not a one-off--but for year after year after year of sustained investment. That is what the NHS needs, that is what the Government are delivering, and that is what the Conservatives would cut back.

Investment on its own, however, will not deliver the goods for patients. The NHS needs sustained reform to run alongside the programme of sustained investment. The fundamentals of the NHS--its principles, fairness and the commitment of its staff--are sound, but major changes are needed if it is to meet the aspirations of the public, staff and patients for services that are faster, fairer and more convenient.

The sustained investment that we are making provides the best ever opportunity fundamentally to redesign the health service around the needs of its patients. The NHS plan that we published last July sets out the essential reforms necessary to transform the way in which the NHS works. They address many of the underlying weaknesses that have bedevilled the NHS for decades, such as old-fashioned demarcations between staff, barriers between services, the lack of clear incentives to provide encouragement for better performance, over-centralisation of decision making and the fact that patients lack real power inside the system. The Bill addresses those fundamental problems which have for too long held back the NHS from realising its full potential.

First and foremost, the Bill is about devolving power from the centre to the local--from the NHS executive and the Department of Health to front-line clinicians, local

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hospitals, primary care groups and, above all others, patients themselves. It transfers the oversight of local primary care services. Let us not forget that in all the discussions about hospitals that inevitably take place in the House--[Interruption.] There must be something happening, Mr. Speaker, because all the Opposition's bleepers have gone off at once. No doubt someone from their Front Bench has gone too.

The oversight of local primary care services--the primary point of contact for patients with the NHS--will be transferred from national quangos to the local health service. The House knows that in the past few years we have strengthened systems of accountability and inspection in the health service. The Bill goes further and offers more support to doctors and better protection for patients. Let me emphasise one important point: the overwhelming majority of doctors do a brilliant job for the NHS, and I believe that it is in their interests, as well as those of the patients, for the few problem doctors whom patients encounter to be dealt with fairly and quickly.

The NHS tribunal system is responsible for deciding whether an individual GP can remain practising within the NHS when concerns have been raised about his or her performance. That system has failed. It has not acted swiftly enough to suspend GPs or remove them from NHS lists when they pose a real risk to patients. The Bill abolishes the tribunal. Its role will be devolved to local health authorities, allowing them to take urgent action when there is a local cause for concern. There will, of course, be a right of appeal to an independent body.

Together with other measures that we are taking, such as the annual appraisal of all doctors, the Bill will provide extra safeguards for patients, including a requirement that previous convictions and judgments by regulatory bodies be reported to the local authority. The new system will be faster, fairer, more flexible and offer better protection for patients.

Dr. Peter Brand (Isle of Wight): I welcome anything that will speed up the control of unsatisfactory doctors, in particular the idea that the disqualification or suspension of a doctor by one health authority will be valid for all other health authorities. However, I am concerned that there is no parallel provision for doctors who are approved to serve on the list of one health authority automatically to be included on the list of other health authorities. That will make life extremely difficult for locums and others.

Mr. Milburn: The hon. Gentleman is aware that, particularly where there are GP shortages, local patients and local health services rely disproportionately on locums. The truth is that, hitherto, we have not had an appropriate structure to ensure that they are capable of providing services of the highest standards to patients. As we all know, there have been unfortunate incidents involving locum GPs.

The vast majority of locum GPs, like the vast majority of permanent GPs, do a first-class job, but some do not. We cannot allow such people to slip through the net, which is why there are proposals to ensure that every health authority list not only includes full-time GPs who work permanently for a practice, whether single-handed or group practices, but registers for the first time locum or temporary family doctors. I believe that that will make

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a substantial difference, certainly in assuring the public that those from whom they receive care and treatment are always of the highest quality, wherever they come from and whether they be temporary or permanent.

Dr. Brand: Perhaps I did not make my question completely clear. The issue is that a disqualification by one health authority disbars a person from working in all health authorities. An approval by one health authority surely should allow a person to be approved automatically by all other health authorities. The Bill does not make that clear.

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