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Mr. Julian Brazier (Canterbury): Although I welcome the extension of the cost of living supplement to Kent, does the Secretary of State realise that all the options for east Kent's acute hospitals involve breaking up our cancer centre? Under any of the four options, complex chemotherapy will not be possible in Canterbury, as it is now, and radiology in the brand new linear accelerator will not be provided with the kind of medical cover that is available at present. Does he intend east Kent to become the first region to have its cancer centre closed?
Mr. Milburn: The hon. Gentleman has raised such issues with me before, and he knows that they are a matter for consultation. It is inappropriate for me to comment on them now. We will await the results of consultation, he will make his representations, as will others, and Ministers will make the appropriate decision. I am glad that he welcomed the increase in fundingan increase of 9.85 per cent. He should talk to those who represent his
Joan Ryan (Enfield, North): First, at my local hospital, Chase Farm, there is a support group called Heart Throbs, who do fantastic work supporting people who need heart operations and their families throughout the process. The group will be extremely pleased with the news today about heart operations, as a number of its members have not survived while waiting for them.
Secondly, we often hear managers in the health service knocked, but many areas of the health service are under-managed. That prevents us from achieving the capacity necessary to provide the hospital services that our patients need. Some of the financing being made available today will rightly be spent on managing our health service. Does my right hon. Friend agree that we should pay tribute to the health service managers who choose to work in the NHS rather than in any other office, because they are committed to the NHS?
Mr. Milburn: I pay tribute to my hon. Friend's local voluntary organisation, which is clearly doing a good job of work. She will see in the consultation paper that we issued today our plans to involve the voluntary sectorsuch as those organisations offering care and support for heart patientsin the new initiative to offer choice to people. If people are to exercise choice, it is important that they do so in an informed way and that the options are fully explained to them. One of the best ways of doing that is by involving the voluntary sector, not just the statutory sector.
On my hon. Friend's second point, NHS managers do a brilliant job of work, sometimes in difficult circumstances. As we delegate and devolve resources and responsibilities from Whitehall and from health authorities to local primary care trusts, it will be important that the trusts have adequate management resources to ensure that they can fulfil their responsibilities and give local communities the services that they deserve.
Mr. Desmond Swayne (New Forest, West): What satisfaction does the Secretary of State take from the ambition expressed by the Chief Secretary to the Treasury in the House earlier today to match by 2004 the European average health expenditure as it was two years before the end of the last century?
Mr. Kevin Hughes (Doncaster, North): I warmly welcome my right hon. Friend's statement and congratulate him on securing a great deal from the Treasury; that must have been pretty difficult[Laughter.] Opposition Members obviously have no experience of the Treasury; at any rate, they are out of touch with it.
What guarantees can my right hon. Friend give my constituents that, this time, more of the extra money going in reaches the front line? That will mean that my constituents will not have to wait, either to see a GP or for an out-patient appointment with a consultant.
Mr. Paul Goodman (Wycombe): Does the Secretary of State believe, in connection with today's spending announcement and, indeed, future spending announcements, that spending on health would be better financed either wholly or partly by a hypothecated health tax?
Mr. Andrew Miller (Ellesmere Port and Neston): My right hon. Friend's statement will be most welcome in my constituency, following the statement earlier this week by my right hon. Friend the Secretary of State for Transport, Local Government and the Regions. Building on capital investments in mental health, oncology, day surgery and so on in the area, today's statement is a tremendous step forward.
I should like to ask my right hon. Friend about the plans for next year that he mentioned. As he is aware, in some polarised areas, the formulas that distributed money through the old standard spending assessment were hugely problematic because they dealt with averages rather than pockets of deprivation. Will he ensure that his new formula on distribution to primary care trusts does not make the same mistake as the Tories' SSA formula and addresses the needs of deprived communities?
Mr. Milburn: My hon. Friend makes an excellent point. It is important, as we put the new formula in place, that cash goes to the areas of greatest health need; we must do that. We have already made a health inequalities adjustment to the existing formula. I expect precisely the same considerations to be embedded in the new formula. It is important that health authorities, given the resources that are available to them this year, apply an appropriate pace of change policy to their local primary care trusts and the money that they get, so that we can begin to close the gap between those PCTs that are over capitation and those that are under capitation. In that way, we can get a fairer settlement, not just for health authorities but for the new PCTs.
Mr. Milburn: Substantial extra investment is going into North Yorkshire for investment in health services; there has been an increase of 9.84 per cent. for 200203, which is a big sum of money. It will be for local PCTs and the strategic health authority to decide how best to deploy that money. Some of it is earmarked for national priorities which, we believe, are patients' priorities: waiting times, primary care, and investment in cancer and coronary care. But the overwhelming bulk of resources will be deployed by local PCTs and health authorities. They must address the pressing health needs of their local communities. If there is a need to invest in dentistry, they will have to look at that.
Roger Casale (Wimbledon): I thank my right hon. Friend for his statement and for the massive cash injection that he has given to Merton, Sutton and Wandsworth health authority, which serves my constituency. Some years ago, after years of being starved of resources by the Tories, that health authority published an annual report entitled "The River Runs Dry", simply to get its message across. He is absolutely right to say that, as we build capacity in south-west London by investing in more nurses, doctors and surgeons, it is vital that we take forward fundamental reform of the way in which the NHS identifies and responds to health care priorities and needs in our local communities.
Does my right hon. Friend agree that there is a special responsibility on some of the new organisations that are being called into existence by his reforms within the NHS familysuch as the Nelson and West Merton primary care trust in my communityto work with community health trusts, which will be wound up because of the reforms? We must ensure that the new organisations pick up the good experience and expertise within existing organisations and, at the same time, develop their own best practice and spread it to other organisations in the local health community.