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Mr. Steve Webb (Northavon): A frequently expressed truism is that we should focus less on the national health service and more on public health itself and the prevention of illness. Would the Secretary of State consider establishing a people's health survey, rather like the labour force survey, which would be conducted continuously? Every month or every quarter, we would be given information not about how many operations were being performed, but about how healthy people were. That might focus our attention on whether we could keep people healthier, rather than on whether we could ensure that more operations were carried out.
Mr. Milburn: I do not know about the specifics, but the hon. Gentleman's general point is important. For too long the debate, in this country at least, has been more about health inputs and structures than about health outcomes.
When we produced the coronary heart disease blueprint a year or so ago, one of the most striking figures that emerged—which, as the blueprint was drawn up by clinicians, had some force—related to the time which people wait for heart operations. Reducing the maximum wait to three months would save approximately 600 lives a year. We need desperately to do that because too many people are waiting for too long. Moreover, taking some simple steps in primary care—prescribing statins, aspirin and so forth, and doing so more effectively—could save 1,800 lives a year.
We need to strike a balance between prevention and treatment. Sometimes the debate, certainly in the NHS itself, suggests that one must be chosen above the other. It is rather like the debate about primary and secondary care. If it came to choosing between the two, we might as well all give up and go home now. We need good primary care services, and good secondary care services. Even more, we need good preventive services.
The hon. Gentleman's point about reporting is interesting. As he knows, we have set ambitious targets to try to ensure that the number of deaths from, in particular, coronary heart disease and cancer is reduced, and we shall want to report to both the public and the House on a pretty regular basis.
Mr. David Heath (Somerton and Frome): I thank the Secretary of State for his thoughtful reply to my hon. Friend the Member for Northavon (Mr. Webb). May I test him further on primary care? As he knows, the ability to recruit and retain general practitioners is now a real issue.
He has told us that more people are entering GP training, but is he as concerned as I am about the number who are leaving general practice in their 50s, never to return? We are losing experienced practitioners.Is there anything in the Bill—or can the Secretary of State do anything—to keep GPs aged 50 and over in practice? That is needed in Somerset, but also, I suspect, throughout the country.
Mr. Milburn: I cannot promise the hon. Gentleman an equally thoughtful reply, but I shall try.
I am less pessimistic than the hon. Gentleman about the number of retiring GPs. Data from the NHS pensions agency suggest that early retirements are and will remain more or less static in terms of the age at which people are retiring. I think that the average retirement age is about 62; if I am wrong, I will write to the hon. Gentleman.
As the hon. Gentleman probably knows, we have been working on the issue, partly because of concerns that have been expressed. We submitted some evidence to the Doctors and Dentists Remuneration Review Body as part of our evidence on pay this year. I am relatively satisfied that the number of entrants and the number of retirements are not out of sync; what we must do, however—as I think I have said in the House before—is achieve a better balance in a doctor's career.
Rather bizarrely in my view, we are getting doctors into practice and working them hard throughout their lives, but working them harder as they approach retirement than at the beginning of their careers. In most walks of life that does not happen. As we expand the capacity of the NHS, we need to view doctors' careers—and, indeed, other careers—in what could be described in a much more fragmented way. We should get them to work hard and give a big service commitment during the early part of their careers, but towards the end of their careers we should harness their commitment and expertise for the benefit of the next generation of doctors. Those issues will need to be dealt with during the discussions and negotiations that are taking place now on the GP contract.
On the first main measure—devolution—when we came to office GP fundholders controlled about 15 per cent. of the NHS budget. Today, primary care groups and primary care trusts control over 50 per cent. The Bill will give doctors and nurses in PCTs the power that they need to match local services to the needs of the local communities that they serve. The Bill paves the way for PCTs to control up to 75 per cent. of the total health service budget. As Ian Bogle of the British Medical Association has rightly said, this is
- "a dramatic move away from centralised health authority control"
- "should bring decision making closer to the patient."
With this Bill we can go further still. It will abolish health authorities as they currently exist. The NHS regional offices will go, too. As our manifesto promised, to reinforce the actions that we need to take to improve recruitment and retention, not just of doctors and nurses but of other staff, we will use the £100 million that we save to improve child care for working parents in the
NHS. Improving services relies on staff having greater involvement and a greater say. In the way it is organised, the NHS needs to give control to front-line services where patients and professionals interact.That brings me to the second major measure in the Bill. A health service designed around the needs of patients must give more power to patients. The present structures for giving patients a voice in the NHS lack teeth and are out of date. Community health councils were a bold innovation more than quarter of a century ago. Many have done a good job, but who in this House, still less in the service itself, believes that public expectations, either as citizens or consumers, remain unchanged from the 1970s?
Mr. David Hinchliffe (Wakefield): Does my right hon. Friend accept that on the Labour Benches and, I think, elsewhere, there is a feeling that the Government have yet to present a coherent case for the abolition of the CHCs? It is as though they have been found guilty and sentenced to death, and we have yet to hear the case for the prosecution. Can he give us some concrete arguments as to why the CHCs need to be abolished and why the system proposed in the Bill will be better?
Mr. Milburn: If my hon. Friend insists, I will try to do precisely that.
Just as reform is needed elsewhere in the NHS, reform of the CHCs is needed too. As the Kennedy report, which I am sure my hon. Friend and others have read, made clear:
- "the public should be on the inside rather than represented by some body on the outside."
Helen Jones (Warrington, North): Will my right hon. Friend give way?
Mr. Milburn: May I go just one stage further?
I know that in this House and in the other place there have been concerns about the replacement of community health councils. As hon. Members are aware, there is much interest outside the House, too, evidenced by the more than 1,000 responses we received to our recent consultations on the proposals.
Mr. Oliver Heald (North-East Hertfordshire): It says here.
Mr. Milburn: It does say it here because it is a speech that I wrote earlier, believe it or not. I thought that that is what I was here to do. The hon. Gentleman sits there and makes benign and stupid comments.
The Bill strengthens the patients' voice inside the NHS. The CHCs had no role in primary care; patients forums will have that role. The CHCs were refused the right to inspect GPs' premises; patients forums will have that right. The CHCs were partly appointed by the Secretary
of State for Health; patients forums will all be appointed independently of both the Secretary of State and indeed the NHS. The CHCs had no formal rights of representation within NHS organisations; patients forums will elect, as of right, one of their members to sit on every trust board. This is about not diminishing patients' rights in the health service, but increasing patients' rights in the health service.
Helen Jones: Does my right hon. Friend accept that if we are to strengthen the voice of communities and patients in the health service, we have actively to seek to involve people from communities that are currently under-represented in the NHS's decision-making process? Will he give us an assurance that the commission will actively seek the involvement of people from deprived communities not only on advisory bodies, but in the NHS's decision-making process?
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