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Mr. Kelvin Hopkins (Luton, North): Events this week in Italy have served to highlight once again serious divisions on the economic philosophy of the European Union. On one side, there are those who want privatisation, extreme liberalisation, an attack on workers' rights and a weakening of welfare states, while on the other there are people such as our own Chancellor—he made this clear yesterday—who want to improve social protection, and those in our trade union movement who want to improve workers rights. Will my right hon. Friend make a day available for a further debate on the future economic direction of Europe?

Mr. Cook: I have just got into trouble for not having a day's debate on Scottish politics, so I would hesitate to

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offer a day's debate on Italian politics, although like my hon. Friend I noticed the massive number of people who took to the streets to express their commitment to ensuring a secure future for themselves at work. Of course, we have taken very powerful measures to ensure that the prospects of people at work are improved. In particular, we have taken measures ensuring that many more people are at work than when we came to office—1.5 million in total—and that we have the lowest unemployment that either his or my constituents can remember in a generation.

Miss Anne McIntosh (Vale of York): Will the right hon. Gentleman now kindly agree to a debate in Government time next week on the vexed question of rail freight passing through the channel tunnel? The Secretary of State for Transport, Local Government and the Regions gave evidence to the Transport Select Committee last week and said that the French would put up a fence to prevent asylum seekers from storming the tunnel, as they have again done this week. However, the trains' failure to materialise is affecting constituency companies such as Potters of Melmerby as well as English, Welsh and Scottish Railways, and is costing £500,000 a day. Can we now please have an urgent debate?

Mr. Cook: I congratulate the hon. Lady on the assiduity with which she has raised this issue. I have raised her concerns with my colleagues at the appropriate Departments. We have obtained commitments from both the French authorities and SNCF that security would improve, and efforts have been made in that regard. We are not there yet, but we will continue to try.

I remind the hon. Lady that we have so far made good progress on tackling the arrival of those who are the source of the insecurity. The number of clandestines and people without proper documentation who are arriving has dropped sharply. We will continue to do all we can on our side, and to press the French authorities to do all they can on their side.

Kevin Brennan (Cardiff, West): I welcome the fact that the Government have today sent their interim response to the Select Committee on Public Administration on its report on the House of Lords. Will he give an assurance that there will be an opportunity for a debate once the Committee has had a chance to consider the Government's interim response and make its comments?

Mr. Cook: I am very happy to say to my hon. Friend that I am under no illusion that this issue will go away. There will be many opportunities for the House to return to it in future, including in two weeks' time when I answer oral questions. The Government will continue to make progress on the issue, so as to ensure that we will be in a position to examine it at some length at a future stage in this Session.

Mr. Graham Brady (Altrincham and Sale, West): The Leader of the House will know that the Government will face probable defeat in another place today on the Export Control Bill, when my noble Friend Baroness Miller of Hendon moves with cross-party support an amendment that seeks to defend academic freedom. If the Government are to persist in their policy of trying to constrain

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academic freedom, can we have an early statement from the Department for Education and Skills about the likely effect on Britain's universities, how they will continue to attract international students, and the effect on our research base?

Mr. Cook: The hon. Gentleman creates a worry and a risk on stilts in relation to a modest aspect of the Export Control Bill. I am proud that we are introducing such a Bill; it is much needed and is based on a commitment that we made and are now carrying through. I am pleased to tell him that we are seeking to introduce amendments that will take care of concerns about academic freedom that we think are rather exaggerated, although we know that they are widely held.

Mr. George Osborne (Tatton): May I press the point made by the hon. Member for Hornchurch (John Cryer), who is no longer in his place? If there is to be a debate on the state funding of political parties, as the Leader of the House says, surely that should include a debate in this Chamber. Given that he says that there is no collective Government position on the matter, will members of the Cabinet be able to speak in the debate, so that the Home Secretary can tell us why he thinks that it is inevitable, the Transport Secretary can explain how he is examining other countries' systems and the Leader of the House can take us on a trip down memory lane about his various political views?

Mr. Cook: The hon. Gentleman asks for a free debate. I should be tempted to have such a debate—having first reached agreement with the right hon. Member for Bromley and Chislehurst (Mr. Forth)—if the many right hon. and hon. Members who were Conservative Cabinet members in the past would take part and tell us exactly where they got funding from and which companies gave them donations.

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NHS Plan

1.16 pm

The Secretary of State for Health (Mr. Alan Milburn): With permission, Mr. Deputy Speaker, I wish to make a statement on the next steps on the NHS plan. I am today laying before Parliament a Command Paper setting out those next steps, copies of which have been placed in the Vote Office.

The NHS plan that we published in July 2000 set out a 10-year programme to rebuild and renew the health service in our country. It diagnosed the NHS problem as follows. The principles of the NHS are right—on this side of the House we believe in an NHS that is free at the point of use, funded from general taxation, and based on need, not ability to pay. But today's NHS is the product of decades of underinvestment. It is also the product of a failure to reform. Staff—the greatest asset that the health service has—work flat out in a system which still too much resembles that of the 1940s. The NHS plan set out a 10-year programme of investment and reform based on clear national standards, more devolution of resources, greater flexibility for staff and more choice for patients.

With the economy stabilised and the public finances sorted out, the 2000 spending review was able to give the NHS the largest ever real-terms increases in resources. Two years later, anyone who says that there are no problems in the NHS has clearly got it wrong, but those who say there has been no progress have also got it wrong. Yes, there is a long way to go—it is a 10-year plan—but those who point to an NHS black hole should in fact be pointing to dozens more hospitals, hundreds more beds, thousands more doctors, tens of thousands more nurses—and a better health service as a result.

In July 2000, we acknowledged that three years of sustained funding was not enough. My right hon. Friend the Prime Minister had already said in January 2000 that we needed to match European Union levels of spending. Yesterday, my right hon. Friend the Chancellor of the Exchequer put NHS finances on a sustained footing, not for three years, but for five. Years of failure to invest in the past are now being replaced with years of investment for the future. Today, I can tell the House what that investment will give us: 35,000 more nurses, 15,000 more doctors, 40 new hospitals and 500 primary care centres. As investment grows, so the capacity of the NHS will grow.

Investment in the NHS must, however, be accompanied by changes in the way in which the NHS works. Ours is not an unconditional offer. Without those reforms, we will not get the best use of the money for the taxpayer and we will not get the improvements in service for the patient. Where we have had the courage to invest, we must now have the courage to reform. Our formula is simple: investment plus reform equals results.

First, building on the national standards already in the NHS plan, we will strengthen the system of inspection and audit to improve accountability to patients and the public. Where more resources are going in, people have the right to know what they are getting out. We will therefore legislate to establish a new Commission for Healthcare Audit and Inspection to inspect and to raise standards in health care across our country. We are clear that we need higher standards in NHS hospitals and also in private hospitals.

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The commission will assess the performance of every part of the NHS so that the public can see that every extra pound in the NHS buys something better for patients and gets something more for taxpayers. Similar arrangements will be made for social care. We will discuss the details of both with the National Assembly for Wales.

The new commission will be independent of both the NHS and Government, and more independent than the current fragmented system. It will report annually to Parliament, not Ministers, on the state of the NHS, its performance and, most important, the use to which it has put the extra resources. The Government should not be judge and jury of the NHS. The commission will be the judge, the British people the jury.

Secondly, we can go further in extending devolution in the NHS, building on what has been achieved. The health service should not and cannot be run from Whitehall. The NHS is delivered in hundreds of different communities by more than 1 million staff. The relationships are between the local patient and the local doctor; the local community and the local hospital. However, those relationships will not work properly until central control is replaced by local accountability. After 50 years, the time has come when the sound of bedpans being dropped in Tredegar should reverberate only in Tredegar.

With national standards and inspection in place, power, resources and responsibilities must now move to the NHS front line. When we came to office, GPs controlled only 15 per cent. of the total NHS budget. Today, primary care trusts, with GPs and nurses in the lead, already control half the budget. In only two years, they will control three quarters of it. Just as the new commission will report nationally, so primary care trusts will need to report locally on how NHS resources have been spent.

The best primary care trusts, like the best NHS hospitals, should enjoy greater freedoms and more rewards. We will therefore establish new foundation hospitals and foundation primary care trusts, which will be fully part of the NHS, but with more freedoms than they have now. They will have more powers, including a right to borrow, to expand their services for patients.

Thirdly, further to the new powers that we have given nurses and others, we will radically alter the way in which staff work and introduce a new system of financial incentives throughout the health service. We will put in place new contracts of employment, not only for nurses and other staff, but for GPs and, yes, for hospital consultants, too. Our objective is to liberate the potential of all members of staff, rewarding those who do most in the NHS and, crucially, improve productivity throughout the health service.

New incentives for individual members of staff will be matched by a new system of financial incentives for NHS organisations. The hospitals that can treat more patients will earn more money. Traditional incentives work in the opposite direction. Indeed, the poorest performers often get the most financial help.

We will therefore introduce a new system for money to flow around the health service, ending perverse incentives and paying hospitals by results. The incentive will be to treat more patients more quickly, and to higher standards.

Fourthly, patient choice will drive the system. Starting with those with the most serious clinical conditions, patients will have a greater choice about when and where

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they are treated. From this summer, patients who have been waiting six months for a heart operation will be able to choose a hospital, public or private, which has the capacity to offer quicker treatment. This level of investment means that we can grow NHS capacity as fast as it is possible to do so.

I can also say today that it is our intention to draw into this country additional overseas capacity so that we can further expand NHS services to NHS patients. As capacity expands, so choice will grow. Within three years, all patients, with their GPs, will be able to book hospital appointments at a time and a place that is convenient to them. The reforms that we are making will mark an irreversible shift from the 1940s take-it-or-leave-it, top-down service. Hospitals will no longer choose patients; patients will choose hospitals.

Reductions in waiting times to get into hospital must, of course, be accompanied by cuts in waiting times to get out. Older people are the generation that built the health service, and they have supported it all their lives. This generation owes that generation a guarantee of dignity and security in old age. Bed blocking denies both.

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