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Mr. Chris Mullin (Sunderland, South): Is my right hon. Friend confident that he will have the full co-operation of the royal colleges and the British Medical Association in his effort to reduce waiting lists? He will be aware that those mighty vested interests have in the past been part of the problem rather than the solution. Is it true that the consultants are demanding a 29 per cent. wage increase in return for their co-operation? If it is, will he politely tell them that that is not on?

Mr. Milburn: I do not know about the specific figures but, clearly, negotiations are taking place with the BMA about the future of the consultant contract. There will no doubt be different points of view. It is important that people recognise that, although these are large increases in NHS investment, they must go to the right place so that we can improve services and, of course, motivate staff. As my hon. Friend will recognise, we require some profound changes—not just increases in the number of staff but changes in their working practices. We cannot have ancient, traditional demarcations among those working in the NHS standing in the way of improved patient care.

Mrs. Angela Browning (Tiverton and Honiton): What is it about the Audit Commission that makes it insufficiently independent or professional to continue to monitor the outcomes of this Government's policy? Why is the Secretary of State dropping the Audit Commission in favour of a body that will be both judge and jury, setting targets and monitoring outcomes?

Mr. Milburn: The hon. Lady has not listened to what I have said; fair enough. Perhaps she can read my statement. I shall briefly explain. The commission will be more independent not less. At the moment, I appoint

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people to the Audit Commission. She might think that that is a perfectly reasonable, independent system; I do not. In future, the people appointed to the Audit Commission—the commissioners—will be appointed independently from me. What is more, the commissioners will appoint the new chief inspector, who will have overall responsibility for ensuring that standards and accountability work in the NHS.

Mr. Chris Pond (Gravesham): Does my right hon. Friend accept that his statement will be warmly welcomed by my constituents, not least, I suspect, because one of the new hospitals that he mentioned is likely to be the community hospital in Gravesend? He will be aware that, despite quite substantial increases in resources, we have had considerable problems with social services in Kent. Will he give us an assurance that the annual report to Parliament on delivery in health services will include local authorities that, given the extra resources that they will be receiving, are failing to deliver effectively on social services?

Mr. Milburn: My hon. Friend makes an extremely important point. It is incumbent on all parts of the public services—particularly if extra investment is going into them, as it is into social and health care—to account for how money is spent and, indeed, for how standards are improving. As I said in my statement, just as we will have a new independent commission to ensure that standards are high and performance in the NHS is improving, so we will have a new independent commission for social services—effectively bringing together the social services inspectorate, which is currently part of the Department of Health, and the National Care Standards Commission. Once again, the new commission that will deal with social care inspection will be more, rather than less, independent than current arrangements.

Mr. Andrew MacKay (Bracknell): Just how will the increases in national insurance contributions and taxation help the NHS in the Thames valley, where due to very high housing costs, we are suffering a desperate shortage of staff and difficulty in recruiting doctors, nurses and all forms of health professionals? Surely such increases will make matters much worse.

Mr. Milburn: All of that was taken into account in discussions on the Budget and the spending review. People are talking about £200 million for the NHS in increased national insurance contributions. To put that into perspective, it is worth remembering that the NHS will be getting an extra £5 billion. The question for the Conservative party is whether it backs that level of investment—yes or no? It is a very simple question.

Dr. Desmond Turner (Brighton, Kemptown): I too congratulate the Secretary of State on his bold measures. I am particularly glad about the extra resources for social services because, as I am sure he will be aware, one factor that contributes to bed blocking, especially in my part of the world, is a lack of capacity in the private and nursing care home market. Will he consider encouraging where necessary public reprovision of long-term care beds?

Mr. Milburn: In the end, those decisions are best taken not by me, but locally. It will be a matter—[Interruption.]

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The hon. Member for Oxford, West and Abingdon (Dr. Harris) says no, but he is the one who continues to argue that the NHS, social services and local government are too centralised. Then, he rails against our saying that decisions are best taken locally. It is for social services and the health service to decide how best to spend the resources. There are many models of providing health and social care. Indeed, it would be good if there were more joint ventures between the public and private sectors precisely so that we could reap the benefits of both, and that way improve patient care.

Dr. Jenny Tonge (Richmond Park): Will the Secretary of State assure the House that the extra doctors and nurses who he has trumpeted this morning will not be recruited either directly by the health service or indirectly through private agencies from developing countries that need them much more than we do?

Mr. Milburn: Yes, we are very clear that we will not be doing that.

Ms Dari Taylor (Stockton, South): In warmly welcoming the statement, I ask my right hon. Friend how successful innovatory practices are being communicated, as there are many in existence. I bring to his attention the Medical Assessment Unit at the James Cook hospital in Middlesbrough. It is in the process of putting together a multidisciplinary, rapid reaction force—if Members will excuse the use of Ministry of Defence language—with outreach nurses and social services. It is effectively discharging 40 per cent. of patients who would otherwise have remained in hospital. This is an excellent piece of innovatory medicine—other hospitals are discharging only 10 per cent. of such patients. How are these good practices being communicated?

Mr. Milburn: First, throughout the health service and social services, as in my hon. Friend's area, there are many examples of innovation, reform, modernisation—call it what we will. The Conservative party would like to pretend that reform has not taken hold when in fact it has taken hold in all aspects of the health service. The way in which we ensure that we learn from best practice is straightforward. First, we now have a modernisation agency that can help people to improve their services. In that way, we take good practices out of the ghetto and spread them to all so that they are not just for the benefit of the few.

Secondly, it is important to get in place the right incentives. I believe profoundly that we cannot simply tell people to change but must provide the incentive for them to change. The truth is that there has never been a system using the right incentives in the national health service and perhaps in social services too. By changing the way in which money flows around the system, we are trying to put the right incentives in place so that those who do best get most money and those who do less well have an incentive to improve.

Mr. Christopher Chope (Christchurch): The Secretary of State makes much of this independent inspectorate reporting to Parliament. Can he guarantee that when it does report to Parliament, there will be an opportunity,

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in Government time, to debate that report on the Floor of the House every year? Can he explain to my constituents how it will improve the morale of people who work in the national health service if their take-home pay is cut by national insurance increases?

Mr. Milburn: On the first issue, that is not a matter for me. I am trying to get rid of powers, not take them on. The Leader of the House deals with such issues. On national insurance contributions, I think that doctors, nurses, therapists, scientists and everyone who works in the national health service recognise that if we want world-class health care, we have to pay for it. The choice that we have made is to put the investment into the national health service. The choice for the hon. Gentleman, with respect, is whether he will match those extra resources.

Mrs. Joan Humble (Blackpool, North and Fleetwood): I applaud the additional investment, especially in social services, and the announcement of additional resources to care for elderly people. That will certainly be welcomed by residents of Lancashire care homes and elderly people supported in the community. Will my right hon. Friend also discuss with local authorities the need to invest in children's services? There are increasing numbers of children at risk who need support and this is an opportunity to offer them that support.

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