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Dr. Evan Harris (Oxford, West and Abingdon): The additional funding announced by the Secretary of State is welcome. It is right that such increases should come from general taxation and not from an increase in chargingeither from new charges or an increase in existing charges. An honest approach would have been for the Government to say before the election that tax rises were needed, rather than skulking back just afterwards with that admission.
Is the right hon. Gentleman concerned that the only taxes that the Government have said that they will not put up to pay for that much-needed investment are fair taxesdirect taxesand they will instead use indirect, regressive and stealth taxes?
I cautiously welcome the changes in the formula, because health inequalities need to be tackled and we need to ensure that living costs are recognised, but the Secretary of State seeks to have it both ways. He says that he wants to delegate more power to local primary care trusts, while taking a huge centralising decision yesterday so that all the guidance from the National Institute for Clinical Excellence
Dr. Evan Harris: Can the right hon. Gentleman defend his statement that he is decentralising when the Minister in the House of Lords announced that the first call on all this funding will have to be to pay for the NICE guidance? Does he recognise that maximum waiting times are arbitrary and that they create clinical distortion, as they force more urgent patients to wait longer while treatment is given to the politically prioritised patients, who are embarrassing to the Government? Of course, patients should not wait long, but that should be a clinical decision, not a political one.
Does the right hon. Gentleman accept that giving patients choice is of limited value when they do not have quality services to choose from, when they do not have access and when it is not fair? He talks in his document about patients choosing not to choose and preferring not to travel, but he will know that some patients are too sick to take up the option of travelling that he wants to provide.
Can the right hon. Gentleman guarantee that the private sector will provide value for money, when he has to pay over the odds for agency-based staff and more expensive private sector staff? Does he recognise that there are no doctors and nurses hanging around waiting to do that work in the private sector? They will be recruited from the pool of doctors and nurses serving the NHS, further limiting capacity.
Finally, at the last Health questions, I asked the right hon. Gentleman how he will guarantee the quality of treatment abroad. How will he provide for relatives to travel abroad? Who will patients sue? Who will the Government blame? How will consent be given in other languages? The document gives no answer, except that suitable arrangements will be made to enable a relative or friend to accompany the heart surgery patient abroad. That is a new kind of rationingpeople can be visited by only one friend or relative.
Mr. Milburn: That was pretty tame stuff. I am surprised by the hon. Gentleman's position on NICE and the financing of drugs, because I understood that the Liberal Democrats were concerned about the fact that NICE had sometimes made recommendations and not every health authority had taken them up. He is either against the lottery in care or he is not. Which is it? [Interruption.] He says that he is against the lottery in care. That is good news, so I look forward to hearing him support the Government's proposals.
On maximum waiting times, the hon. Gentleman knows as well as I do that patients' biggest concern about the NHS today is not the quality of care that they receive when they go into hospital, or even when they go to their GP's surgery, but the wait for treatment. It is proper that we address that. Of course, the most serious and urgent conditions should come first. That is why we have taken the right step, through the choice initiative, which is to make choice available to the patients who suffer from the most serious clinical conditions: those waiting for heart operations.
In my discussions with constituents and when right hon. and hon. Members have raised the issue, I have been struck too many times by the very real dilemma faced by people who have a bit of savings. Those who have bothered to save all their lives and then realise that they need a heart operation face the awful dilemma of either having to wait for treatment or to pay for it. The only choice that they have right now to get a shorter waiting time is to opt out of the NHS.
I believe profoundly that people should have the choice of being able to stay in the NHS, rather than having to leave it. Yes, that is new, it will be difficult to do, and the hon. Member for Woodspring (Dr. Fox) asked about the maximum six-month wait and so on. That is what we need to achieve, but we shall start with the heart patients and test other approaches and pilot schemes in other parts of the country in due course. We have to get it right. It is right to take a cautious approach but I hope that patients will welcome our initiative, which will be introduced from the middle of next year.
The hon. Gentleman is right to ask about value for money and the private sector. The answer is that we need to negotiate a good deal on behalf of patients and taxpayers, and that is precisely what we shall do. However, I could not stand here as the Secretary of State
Mr. Chris Pond (Gravesham): Is my right hon. Friend aware that my constituents in Gravesham will certainly welcome his statement, especially his extension of the cost of living supplement to Kent? He will know that that will provide us with a real opportunity not only more properly to reward the staff who work so hard in the service, but to compete effectively with London boroughs in the recruitment and retention of staff.
My constituents will also welcome the fact that my right hon. Friend has shown clearly that he sees the NHS as a service with a future that is worth investing in as a publicly funded service free at the point of use and not as a Stalinist creation to be privatised and impoverished.
Mr. Milburn: I very much agree with my hon. Friend. When I referred in my statement to the representations that I have received, I was thinking of him and Members on both sides of the House who have made representations about Kent, Essex and other places. It is right that we close the gaps in the cost of living supplement.
I represent a north-eastern constituency, and I know that the cost of living there is different from that in the south-east. I also know that there are huge inequalities in parts of the north and the midlands that do not always pertain in all parts of the south, so it is important that we get the balance right.
On my hon. Friend's more general point, there is a big debate taking place in the country and it is the right debate to have. We recognise that, for decades, the NHS has not had the resources that it needs, and we need to plug the gap. The question is how best we do that. Labour Members say that the best way is investing in the NHS and reforming it. We do that through general taxation. People will conclude that the Labour party and this Government are the party of choice for patients in the NHS while the Conservative party is the party of charging for patients.
Peter Bottomley (Worthing, West): Will the Secretary of State take this opportunity to pass on to all the staff in the NHSthe ancillary, nursing and medical staffour thanks for what they do for 365 days a year? Will he also acknowledge that the pressures on patients are also pressures on staff?
As we do not yet know the allocations for our areas, we cannot talk about them even though, given the Secretary of State's description, we await them with interest. However, we know that he is not announcing new money today, because it was announced last week by the Chancellor and in the public expenditure statements.
How soon does the Secretary of State believe that there will be a significant change in the performance of health authorities with patients waiting more than a year for treatments? I think that I am right in saying that 19 out of the 20 authorities with patients in that position are, in effect, Conservative areas. For example, in the West Sussex and West Surrey health authorities, one in 10 patients wait more than a year. However, 19 out of 20 authorities where no one waits more than a year are
Mr. Deputy Speaker: Order. The hon. Gentleman has had more than his share of time. Before I ask the Secretary of State to reply, may I remind the House that this is a very important statement. An awful lot of Members wish to contribute and many of them will be disappointed unless everyone asks one question briefly. I hope that the answers will be brief too.
I am sorry that the hon. Member for Worthing, West (Peter Bottomley) has not yet received the letter that explains the increases for his area. In West Surrey, the increase will be 9.57 per cent. and, in West Sussex, it will be 9.58 per cent. I think that he will agree that it is a pretty large increase in funding.
The hon. Gentleman raises considerable issues about how best we distribute NHS resources. We are trying to resolve the tensions by making major changes to the formula for the next financial year, and we are undertaking a fundamental review of the existing formula as a whole. I hope that the review will be concluded later next year, so that it can be implemented from the 2003-04 financial year. The review will need to pay particular attention precisely to some of the issues that he rightly mentions, such as how we get money to the areas of health need while recognising that different parts of the country have different health costs to absorb.