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Dr. Liam Fox (Woodspring): I am grateful to the Secretary of State for his statement.
Well, well, well; surprise, surprise. Just before announcing the date of the general election, the Government produce a wish list for voters, bribing them with the taxes that they have not yet paid--good old Labour party pork-barrel politics. I am grateful to the Secretary of State for pointing out that 6,700 extra doctors have joined the NHS since 1997. Given, as he frequently points out, that it takes five years to train a doctor, every one of them, by definition, began his training under the previous, Conservative Government as part of our programme of expansion. We also provided extra nurses, thanks to the increase of more than a third in the number of nurse training places between 1994 and 1997. The Secretary of State conveniently forgot to mention those facts.
The right hon. Gentleman's announcement is a sham. He is going for great headlines. Although he says that he is giving the go-ahead for 29 projects, let us consider the buts, and there are many of them. He is giving the go-ahead for 29 projects, but each will need to be subject to the normal approval process. There are 29, but each will have to confirm viability and affordability and, before it is finally signed off, value for money.
The first of the hospitals will be opened by 2006. The Government have failed to deliver in this Parliament and have already guaranteed that, should they be re-elected, they will fail to deliver in the next Parliament.
I shall ask some questions to ascertain whether the statement is anything more than headline and whether there is anything substantive within it. How, in detail, will the projects be funded through PFI? What will be the length of the average contract through PFI? What is the expected rate of return? How many of the current PFI projects in the national health service are behind schedule?
The Secretary of State talks about seamless local care. I ask him to think again about the way in which he describes seamless local care for patients. He talks about building primary and intermediate facilities alongside new hospitals. Seamless care is a function not of geography, but of co-ordination of services. It is of little comfort to patients who might be at the periphery of a health area if everything is concentrated in the centre. I hope that the right hon. Gentleman will explain what he really means.
I am delighted, at least in principle, by the concept of fast-track units, as the Secretary of State calls them in his announcement. We described them in our "Believing in Britain" document as stand-alone units. The concept has
Perhaps the right hon. Gentleman will tell us his estimates for the extra numbers of staff that will be required for the units, and especially his estimates of specialist staff. How will consultant care be divided in the units? Will the same consultants be responsible for all junior staff, even round the clock? These are the practical differences between a headline and a policy.
The Government have missed two factors. First, the Secretary of State says that emergency admissions and displaced planned elective admissions sometimes mean that planned operations are cancelled at the last minute, causing distress for patients and frustration for staff. The greatest problem, in terms of cancellation of operations and frustration for patients and staff, is the Government's waiting list initiative, which throughout the country regularly causes cancellation of operations or worse, forcing surgeons to do things that they do not want to do simply to squeeze more minor complaints through the system to get the waiting list down.
Surgeons at Guy's hospital in London say that they have been asked by management to do fewer hip replacements so that they might deal with more minor complaints in the same amount of time. We think that that is an unethical approach to care and that the Government should abandon that failed policy.
Secondly, the Secretary of State talks about the number of beds, including intermediate care beds. We are seeing a huge reduction in the number of care beds in the community--as many as 50,000 in the current year. That will lead to more bed blocking and less ability to provide intermediate care. It will have a knock-on effect on waiting lists because of cancelled elective surgery.
I ask the Secretary of State to answer eight questions. The number of--[Interruption.] I know that Labour Members think that answering questions in the House is bizarre and unusual, but it is why Ministers come to the House. Will the right hon. Gentleman tell us whether the extra nurses that he talked about will be full-time equivalents? When does he expect to reach the average European levels of expenditure on health to which he alluded? What will the length of the PFI contract be for new projects? What will the rate of return be on these contracts? How many current PFI programmes in the NHS are behind schedule? Can he confirm that the option to return a building to the NHS already exists under PFI and is nothing new? What extra staff will be required for stand-alone units and how will they be recruited? How many care home beds does the Secretary of State estimate will be lost this year, making bed blocking more acute?
We await answers to those detailed questions; that is the difference between a Government who live by headlines and a Government who have thought through their policy. We shall judge the Government not on the promises that they are making today, but on their delivery. They promised to cut waiting lists, yet lists have gone up; cut NHS bureaucracy, yet it has increased; abolish trolley waits, yet they are still there; and get rid of mixed-sex
Mr. Dennis Skinner (Bolsover): Are you going to vote against it?
Mr. Milburn: If I may interrupt the dialogue, the hon. Member for Woodspring (Dr. Fox) started by praising his party's record. If he wants to quote his party's record, perhaps he will stand by the record that meant that the number of nurse training places were cut under the previous Government, as were the number of GP trainees. They fell by a quarter under the previous Government, whereas they are rising by a quarter under this Government.
I shall deal with the specific issues raised by the hon. Gentleman. The number of extra nurses, doctors and so on that I announced--which, indeed, were announced earlier today--are head count figures, as they were in the NHS plan. The length of the contract for PFI deals will vary according to local circumstances. We expect that many contracts will be between 15 and 30 years. As for the cost of the contracts and extra personnel to the revenue budgets of the NHS, we expect that it will amount to an extra £300 million of revenue commitments for the NHS, which it is well capable of affording, given the increases that we have made.
On the number of contracts that are behind schedule, I can confirm that not a single contract is behind schedule. Indeed, many PFI contracts are coming in on time and ahead of schedule. The hon. Gentleman said that the option to return to NHS ownership at the end of a contract is nothing new. Well, it was not new under the previous Government because that was not how PFI operated then. We made the change to PFI contracts; in fact, I made it when I was Chief Secretary to the Treasury. That is a new development for PFI.
The hon. Gentleman started with a rather outlandish allegation that the programme was a form of electioneering. It is a strange form of electioneering for a Labour Secretary of State to agree to hospitals in the constituency of the hon. Member for Chingford and Woodford Green (Mr. Duncan Smith), the shadow Defence Secretary; in Colchester, which is in the constituency of the hon. Member for North Essex (Mr. Jenkin), the shadow Transport Minister; and in the constituency of the hon. Member for South-West Devon (Mr. Streeter), the shadow International Development Secretary. It is an odd Labour Secretary of State who embarks on electioneering and agrees to new hospitals in the constituency of the hon. Member for Tunbridge Wells (Mr. Norman), the shadow Secretary of State for the Environment, Transport and the Regions, and that of the right hon. Member for Maidstone and The Weald (Miss Widdecombe), the shadow Home Secretary. It is a very odd Labour Health Secretary who agrees to two hospitals in the constituency of the shadow Health Secretary.
The one thing that the hon. Gentleman failed to do in his speech was confirm that he would match our spending on those new hospitals. The truth is that he cannot match it. He cannot match us on doctors, nurses, beds and
Mr. Bill O'Brien (Normanton): May I warmly thank my right hon. Friend for his statement this afternoon? On behalf of my constituents in Normanton and throughout the Wakefield area, may I give a big thanks, because Pinderfields hospital is in my constituency, and that is where the new development will take place?
It has taken four years of Labour government to provide a new hospital. We appealed for 18 years under the Tories, but got nowhere and today we heard sour grapes from the shadow Health Secretary. We must now get on with the job.
Primary health care provision was allied to my right hon. Friend's statement. Will action be taken to reduce the waiting time to see general practitioners in many of the primary care group areas? Will he assure me that a monitoring system will be established to ensure that PFI delivers the work and goods, as it would be in relation to provision funded by taxation? On behalf of staff and patients at Pinderfields hospital, I express my hope that there will be a speedy start to the development of hospital services.