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Mr. Alex Salmond (Banff and Buchan) rose

Mr. Gregory Barker (Bexhill and Battle) rose

Mr. Bill Wiggin (Leominster) rose

Lynne Jones (Birmingham, Selly Oak) rose

Mr. Milburn: I have given way a lot, and I will give way to the hon. Gentlemen later. For now, I give way to my hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones).

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Lynne Jones: I thank my right hon. Friend. Of course, everyone is pleased about the extra money being made available for the NHS, but there are ongoing concerns about resources for social services. Budgets in that sector are overstretched, and there are not enough places in care homes and nursing homes. Is not my right hon. Friend worried that a policy of fining local authorities over cases of bed blocking may mean that vulnerable people in the community miss out on services? The perverse result could be a rise in emergency admissions. Will my right hon. Friend take that into account as he develops the policies?

Mr. Milburn: First, of course safeguards must be built in. We can no longer allow people's discharge from hospital to be delayed unnecessarily—and neither can we accept a big growth in emergency readmission rates to hospitals. My hon. Friend will have seen in the Command Paper that we issued last Thursday that we intend to ensure that the proper incentives for the NHS and for social services are in place to prevent that.

Secondly, I can assure my hon. Friend that we have examined the question of funding very carefully. The Government have accepted that social services investment must be increased to the extent that is proposed because the Department argued that that is how much is needed to do what needs to be done with regard to services for children and care services for the elderly. The first task is to stabilise the care home market, and expand care home places. In some parts of the country, local authorities will have to decide how to use the extra investment. Increasing fees for residential care homes, for example, will be a matter for local authorities. However, we must also expand the range of provision, and not assume that every old person must end up in a residential care home. Many will want to, but many others will want to retain independence for as long as possible. It is therefore important to make certain that the resources exist to ensure that care is available in care homes, and in people's own homes as well.

Mr. Ian Davidson (Glasgow, Pollok): I welcome the extra money being given to health—so much so that I am now thinking very seriously about voting Labour at the next election.

Is my right hon. Friend the Secretary of State aware of the Arbuthnot report, which proposed that additional money should go to Scotland, and to Glasgow in particular? The city has the worst health record in the UK. The Arbuthnot report was not implemented in previous years because that would have meant taking money from other parts of Scotland. Does my right hon. Friend agree that now that new money is being made available more can go to Glasgow without anyone else suffering, and that it is now possible for Glasgow to get the health care that it needs? [Hon. Members: "Good question."] Thank you.

Mr. Milburn: My hon. Friend has not heard the answer yet.

I am aware of the Arbuthnot report, but it is a matter for the Scottish Parliament, not for me. In England, however, we have an opportunity to address the dreadful health inequalities that are a scar on the face of our country, both by ensuring that we get the right investment to the right parts of the country and by waging an unrelenting war on the diseases that kill the most people

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in this country—cancer and coronary heart disease. We have made a start; now we have the opportunity to do much, much more. We have made a good start and we need to build on it.

Essentially, the Opposition's grounds for voting against more investment in the NHS are two. First, they argue that putting resources into the NHS does not yield results; in fact, it does. Secondly, they argue that resources are not being matched by reforms; in fact, they are.

Chris Grayling rose

Mr. Milburn: I have given way about a dozen times, so I shall give way to the hon. Gentleman later.

I want to test each of the Opposition's propositions. First, they say that resources do not produce results. Yes, there are problems in the NHS at present; they are long-standing problems, brought about by failure both to invest and to reform. No one but a fool—and, of course, Members on the Liberal Benches—could believe that a few years of extra investment would put right decades of underinvestment. The difference between the Labour Government and Conservative Governments is that we are both investing and reforming. Waiting lists rose by 400,000 in the years until 1997, but they have fallen by 100,000 during the years since.

Waiting times are falling, too. The number of people waiting more than 12 months for a hospital operation has fallen by one third in only one year. The number of people experiencing long waits for an out-patient appointment is the lowest on record. The total number waiting for an out-patient appointment is lower than when we came into office. For those with the most serious clinical conditions—cancer and coronary heart disease—waiting times are even lower.

Last year, there were 11 per cent. more heart operations and 13 per cent. more cataract operations. Since 1997, the NHS has been treating over 700,000 more in-patients and over 1 million more out-patients.

In primary care, the prescribing of cholesterol-lowering drugs is up by one third. Tens of thousands of patients are receiving the latest drugs to combat cancer, heart disease, Alzheimer's disease and arthritis. In the past year alone, death rates from cancer fell by 2 per cent., and from heart disease by 5 per cent.

Where do Opposition Members think those improvements came from? They did not come about through the invisible hand of the free market. They did not happen by chance, but because of the choice that the Government made to put extra resources into the NHS. Of course, it is true that the NHS is still feeling the effects of decades of underinvestment. It is true that patients wait too long for treatment and that we still have staff shortages. At present, however, the NHS is the fastest- growing health care system in any major country in Europe.

To those who suggest experience abroad as a lesson for our country, I point out that while health spending as a share of national income is falling in France and Germany it is rising in Britain. Decades of neglect are being put right. Resources are beginning to produce results, and because of the Budget we can finish what we started.

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The Opposition say, secondly—

Mr. Wiggin rose

Mr. Milburn: The hon. Gentleman is in a different place, but he does not fool me—unless he is the first successful experiment in human cloning.

Dr. Fox: The clones are all behind the right hon. Gentleman.

Mr. Milburn: I hope not, for all our sakes. I give way to the hon. Member for Leominster (Mr. Wiggin).

Mr. Wiggin: I am grateful to the Secretary of State—I shall change my seat more often, although not in the same way as my predecessor.

The Secretary of State will be aware of the extraordinary situation in Herefordshire—not only because I have written to him about it but because I have raised it on other occasions in this place. Today, as he revels in his largesse, provides him with an excellent opportunity to tell not only the House but the people of Herefordshire that he has listened to what they said and that he is aware that the new hospital to be opened in the autumn will be 120 beds short of the number in the previous hospital. As he knows, the primary care trust said that it requires £6.5 million a year.

Mr. Milburn: More money?

Mr. Wiggin: Indeed—£6.5 million a year. While the Secretary of State is asking us to vote for his Budget, perhaps he will take this opportunity to confirm that the primary care trust in Herefordshire will get that £6.5 million a year and that we can have our extra 120 beds.

Mr. Milburn: It is no use raising those issues with me; the hon. Gentleman should raise them with the shadow Chancellor, who tonight will urge his Back-Bench supporters to vote against extra investment in the NHS, not just in Herefordshire, Kent, Avon or Essex, but throughout the country.

The hon. Gentleman now sees the horns of the dilemma on which the Conservatives find themselves: they say that the health service needs more investment, but they are not prepared to commit more investment. They say that they oppose the sources of the extra investment, but they are not prepared to identify new sources of investment. The right hon. and learned Member for Folkestone and Hythe (Mr. Howard) nods. I suggest that the hon. Member for Leominster dodges around again and goes to the Front Bench to whisper in the right hon. and learned Gentleman's ear and get him to change his mind.

The Opposition say that there is no reform, but the Budget is every bit as much about reform as it is about investment. The NHS plan, which we published in July 2000, is our 10-year programme for change—national standards, more devolution, greater flexibility among staff and more choice for patients. Last Thursday, I set out in the House and in the Command Paper that we published the next steps that we will now take on those NHS plan reforms.

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The opponents of the NHS say that reforms can never be made. They say that the NHS cannot offer patients choice because it is not a market. They say that it cannot be sufficiently accountable to members of the public because it is funded from general taxation. They say that it has to be centralised, so stifling local innovation, because it is a public service.

We say that, with the right programme of investment and reform, the NHS need not be a market, but it can offer patient choice; that it should remain tax funded, yet it can be more accountable; and that it can retain its ethos of public service, yet devolve and diversify its services. So alongside the investment will come a strengthened system of inspection and audit to improve accountability to patients and taxpayers. Where more resources are going in, people have the right to know what they are getting out.

Greater accountability will be accompanied by more devolution. Hospitals will be paid by results, through a new system of financial incentives that will give more rewards to those who can treat more patients, more quickly and to higher standards. Social services will also be paid by results—an issue that hon. Members have raised with me—so we will put in place new incentives to end the misery of bed blocking.

For the first time, patients will be able to make informed choices about when and where to be treated. We will start this summer by offering choice to patients who need heart surgery. As capacity expands, choice will grow for more patients. By 2005, patients, with their GPs, will have choice over the location of their treatment, as well as the timing of their treatment.

The hon. Member for Woodspring cannot bring himself to say that those are radical reforms because to do so he would have to acknowledge that the NHS is capable of being reformed. That is not what Conservative Members have in mind. They do not want to reform the NHS; they have decided to reject the NHS—not that they are yet ready to say in public what they say in private.

Only this weekend on the BBC, the right hon. and learned Member for Folkestone and Hythe told John Humphrys:

The Conservative party has spent months on study tours and city breaks, but as I reminded the hon. Member for Woodspring on Thursday, the purpose of travel is not to travel but to arrive. So when he gets to the Dispatch Box, he has got to do more than show us his postcards—he has to outline his prescription.

The truth is the hon. Gentleman has made up his mind already, as we know from what he told the Conservative Medical Society in Harrogate a few weeks ago. Of course, he felt that it was safe to speak then because it was, as he said,

I have here a copy of The Mirror of 11 April 2002—it is not very flattering, as it describes the hon. Gentleman as "Dr. Death"—in which his speech is extensively quoted. He outlines his four-step strategy to break the NHS. Step one:

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step two: convince them that it has "never worked before"; step three: tell them that it "will never work"; and step four: get more people to "self-pay" for their own care.

That is the strategy that the Conservatives have been implementing. That is why they say that NHS staff treat patients worse than dogs. That is why they dismiss every step in the right direction. That is why they distort every issue. And that is why we will expose their strategy for what it is. It is denigration for a purpose—a cynical attempt to destroy the bond of trust between the British people and the British health service.

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