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Extradition (Amendment)

Mr. John Maples accordingly presented a Bill to amend the law on extradition: And the same was read the First time; and ordered to be read a Second time on Friday 30 November, and to be printed [Bill 52].

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Orders of the Day

National Health Service Reform and Health Care Professions Bill

Order for Second Reading read.

Mr. Deputy Speaker (Sir Alan Haselhurst): Mr. Speaker has selected the amendment in the name of the Leader of the Opposition. I also remind the House that there is a 10-minute limit on speeches by Back-Bench Members.

4.48 pm

The Secretary of State for Health (Mr. Alan Milburn): I beg to move, That the Bill be now read a Second time.

The Bill implements commitments in the national health service plan that was published in our manifesto for the general election. That election presented people with a fundamental choice. For many, it came down to a choice between short-term tax cuts and investment in public services. I am thankful that the British public chose the latter. It was the right choice for Britain, and a choice that the Labour party made.

Some claim that getting patients to pay privately for health care is the only answer to the problems in the national health service. However, Labour Members believe unequivocally that the NHS is the fairest and most efficient way of providing health care for our people. It is based on the right principles of care according to people's need, not the size of their wallets.

Those were the right principles when the NHS was created and they remain the right principles now. It is not NHS principles that need to change but NHS practices. That is what the Bill seeks to address. People today grow up in a consumer society. Services, whether public or private, succeed or fail according to their ability to match modern expectations of service delivery. People exercise more choices in their lives than at any point in history. Many can afford to walk away from public services that do not command their confidence.

Our task as a nation surely must be to make the NHS a service of first choice, not last resort. We in the Government recognise that we cannot build a one-nation Britain on two-tier health care. There is, as we know, a long way to go to give patients the flexible, convenient, high-quality services that they expect. Patients wait too long for treatment. There are staff shortages, dilapidated buildings and outdated equipment.

In their amendment, the Conservative Opposition crow about failings in the NHS. They know a lot about failings in the NHS because they were responsible for many of the present failings. They complain about doctor shortages, but they cut the number of doctors in training. They complain about nursing shortages, but they cut the number of nurses in training. They complain about bed shortages in hospitals, but they cut the number of beds by 40,000. They complain about the state of NHS hospitals, but they were spending less capital at the end of their last Parliament than at the beginning.

Only a fool—and the hon. Member for Oxford, West and Abingdon (Dr. Harris)—would believe that decades of neglect in the NHS can be reversed in a few years of investment. [Interruption.] The hon. Gentleman is good on those figures, and he will get better over time.

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The NHS plan that we published last year is not for one year or for two years, but for 10 years. We need a decade of investment to follow decades of decline. The years of health care on the cheap are at an end. The NHS is growing at twice the rate that it grew at under the Conservatives. Under the Labour Government, it is the fastest growing health care system of any major country in Europe.

Mr. Andrew Hunter (Basingstoke): The Secretary of State refers to increasing expenditure. Does he recall that when he visited Basingstoke during the general election, according to the local media, he reported additional funding for cardiac treatment? The local media have tried to get news on that extra funding from his private office, but have not received a reply.

Mr. Milburn: I will try to be responsive to the local media in Basingstoke. I hope that they are as responsible as the national media on matters relating to the health service. If the hon. Gentleman has specific questions about investment in Basingstoke, in cardiac care or otherwise, I am happy to look into them. If he writes to me, I will gladly write back to him.

Staff, who do such a brilliant job in the NHS, are increasing in number at record rates. There are 6,000 more nurses and 1,300 more doctors in just one year, and there are 20,000 more nurses and 10,000 more doctors to come. The cuts in nurse training and general practitioner training that took place in the 1990s have been reversed. Applications for medical schools, and the number of medical schools, are up for the first time in years. Applications for nursing degrees are up by more than 80 per cent. I can report to the House that the latest figures show that the number of nurses returning to the NHS is well in excess of 9,000.

This year, 1,000 GP surgeries are being improved. Thousands of new intermediate care beds and places have been established. The biggest hospital building programme in NHS history is under way. This year, for the first time in 30 years, the number of beds in NHS hospitals is rising rather than falling.

Dr. Evan Harris (Oxford, West and Abingdon): I am grateful to the Secretary of State for interrupting his flow of statistics. The news about nurses coming back to the health service is welcome. Has he any data on how many nurses are still leaving? Was his figure a net figure or a flow one way?

Mr. Milburn: I reported the number of nurses who left the health service and have now returned. In terms of the number of nurses overall—the number recruited minus the number who have left—I am happy to report that there are 17,000 more working in the NHS than when the Government came to office.

The number of people waiting more than 12 months for a hospital operation is down 13 per cent. in just a year. That is still too long, but we are moving in the right direction. Cancer patients are being seen by a hospital specialist within two weeks when they used to have to wait months. There are 3,000 more heart operations, over 150 more chest pain clinics and 17 per cent. more

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cardiologists. Prescription of cholesterol-lowering drugs is up by over a third in just a year. We are spending more than £250 million in this financial year alone on new drugs for conditions such as cancer, heart disease, dementia and arthritis. None of that progress would have been possible without the investment made by this Labour Government.

No one should fall for the fallacy that, unless every problem in the NHS is solved by yesterday, no problems are being solved today. The programme that we outlined in the NHS plan is well on course to be delivered, but, as we recognise, investment alone will not do the trick. Delivering improvements in care to patients depends on fundamental reform of how that care is organised and provided. Here, too, there is progress.

For the first time, there is a sensible relationship between the public and private sectors to expand the care available to NHS patients. For the first time, there are clear national standards and the ability to implement them. For the first time, there are real incentives to reward good performance and to deal with poor performance. For the first time, I am pleased to say, we are finally getting health and social care working together rather than against one another.

Those reforms are based on one fundamental insight: although the values of the NHS are right for this century, its structures owe too much to the last. Services are too slow. Staff are run off their feet. The NHS is too bureaucratic and too monolithic. In my view, public confidence demands a fundamental change not just in the level of investment, but in the culture of the whole health service, to put patients' needs first in the hospitals and surgeries just as we seek to put parents and pupils' needs first in the schools.

Throughout the past two decades of organisational change in the NHS—there has been a lot of change during those years—the essential post-war structure of top-down control remained largely intact. The result was that, too often, Governments of all political persuasions defended the interests of the NHS as a service provider when they should have focused on the interests of patients as service users.

It is right, of course, that there should be national accountability for the workings of our country's health care system. For the sake of fairness, clear national standards should be applied not just in parts of the country, but across the whole country. It is right, too, that the Government should allocate resources to ensure that NHS cash genuinely meets the greatest health care needs. Beyond that, the old top-down model of the 1940s can no longer be expected to deliver health care in the 21st century.

Vesting control at the centre has diminished control where it counts—in local communities where local health services interact with local people. Our aim must be a more pluralist, decentralised health service that is capable of overcoming bureaucratic inertia and encouraging genuine innovation.

That is what the Bill will help to achieve. It has its origins in the White Paper that we published in December 1997, and the resulting Health Act 1999 abolished the Conservatives internal market, which was fragmented, bureaucratic, divisive and disruptive. While it promised that the money would follow the patient, the patient followed the contract. That market damaged equity and failed to promote patient choice.

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It was right to end that failed internal market. In its place, there are primary care groups and trusts, which put front-line staff in charge of front-line services. The NHS plan, which we published last year, set out our proposals for further devolution. Since then, the important Kennedy inquiry has reported on the tragedies at Bristol royal infirmary. The Kennedy report called for further reforms to move the centre of gravity in favour of a more responsive, patient-centred NHS.

The three big measures in the Bill aim to achieve just that: first, by devolving more resources to front-line services; secondly, by giving local patients more power in their local health service; and thirdly, by strengthening independent regulation of those services. It might help if I deal with each measure in turn.

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