The Secretary of State for Health (Mr. Alan Milburn): All NHS trusts are currently subject to an annual external audit of their financial statements by independent auditors appointed by the Audit Commission. That will not change, although a new commission for health care audit and inspection will be created from the current functions performed by the Commission for Health Improvement, the value-for-money studies of the Audit Commission and the private sector health care work of the National Care Standards Commission. I expect the new commission to be in place, so that it can audit NHS performance, by 200304.
Mr. Milburn: As my hon. Friend suggests, if people are putting more money into the national health service, it is important that they see what they are getting out of it. The truth is that, at the moment, we have a fairly bureaucratic and fragmented system of inspection. That system has evolved in the past few years, but because it is fragmented it weakens inspection. We have an opportunity to combine in a new, strengthened system the integrity and independence of all the various organisations that contribute to regulation not just of the NHS but of the private sector. That system will make the issue of where the money goes and how performance is improving much more transparent to the public.
Mrs. Marion Roe (Broxbourne): Does the Secretary of State accept that Mrs. Drew, a constituent of mine, would welcome a thorough audit as soon as possible of the spending of Barnet and Chase Farm Hospitals NHS trust? On 19 April, she was interviewed by the oncology department consultant in the hospital's new unit, which was opened in February. Unfortunately, she was informed that she has cancer; she was also told that she must be treated at North Middlesex hospital, in Edmonton. Although the new unit at Chase Farm is fully equipped to provide her treatment, there is no funding, and North Middlesex hospital is the only alternative to provide her six-month treatment. When such mismanagement is revealed, how can she have faith in the Government's claim that they are providing services for patients?
Mr. Milburn: I have every sympathy with the plight of the hon. Lady's constituent, and if she cares to write to me, I shall look into the matter. However, she might be aware of the horns of the dilemma that she and her hon. Friends now face. She says that she wants more investment, but she voted against it a fortnight ago.
Dr. Howard Stoate (Dartford): My right hon. Friend will know that the vast majority of hospitals have excellent accounting arrangements and offer exceptional value for money for the NHS system. Some, however, have been unable to meet the Government's strict requirements, and have had to be franchised. How is the franchising process progressing, and when will the Dartford and Gravesham acute trust, in particular, receive some news on when the process is likely to be completed?
Mr. Milburn: My hon. Friend is aware of the good work being carried out in his local hospital, as well as some past problems with its management and organisation. As he says, a franchising process is under way, and I hope to finalise it before too long. In all parts of the national health service, it is very important that, where there are persistent problems with performance, poor management and lack of organisation, they be dealt with. Every part of the NHS deserves the best management because, as he knows, good management makes a huge difference.
Sir Teddy Taylor (Rochford and Southend, East): Does the Secretary of State agree that it is unfortunate that, although the audits tell us that money is being properly and legally spent, they offer no guidance on issues of policy? For example, how much extra does the provision of agency nurses, rather than ordinary ones, cost the health service? How much does the existence of hospices save the health service, given that 72 per cent. of the money comes from voluntary donations? Given that the NHS is not a profit-making organisation but a public body, should not the audit provide wider interpretations of what is happening, where money is being spent, how it could be saved, and the ways in which it has not been saved?
Mr. Milburn: That is precisely the idea behind our proposed new audit arrangements. Obviously, the new commission for health care audit and inspection will require legislation, and that will be a matter for debate in the House. The idea is that, for the first time, one organisation will be responsible for examining clinical standards throughout the health service; for considering performance issues, which my hon. Friend the Member for Dartford (Dr. Stoate) rightly described as important; and for considering where NHS money is actually spentthe issue that the hon. Gentleman raises. The public, who put money into the national health service, will therefore know where it is going and the results that accrue from it.
Paddy Tipping (Sherwood): Does the Secretary of State accept that any strengthened and reformed audit system should look at strengths as well as weaknesses? Will the new system be used to promote success, using the staff and the trusts that develop good and modern practices?
Mr. Milburn: My hon. Friend makes an important point. He knows as well as I do of the many examples of good practice in the NHS. Part of the function of the existing Audit Commission and Commission for Health
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): Cottage hospitals continue to make an important contribution to the delivery of the NHS plan by providing care closer to home. We expect them to be key players in meeting our target of introducing an additional 5,000 intermediate care beds by 2004.
Michael Fabricant: I am grateful for the Minister's answer, which is typically feisty in support of cottage hospitals. The 5,000 beds may make a small dent in the 50,000 care home beds that have been lost since the Government came to power. The Minister will know that the future of the cottage hospital in Burntwood is in considerable doubt. Indeed, I wrote to the Minister of State on 24 January on that point, but he still has not replied to me. As for Lichfield, the Minister will know that on 15 May the Burntwood, Lichfield and Tamworth primary care trust will recommend the building of a new hospital in Lichfield. Will that new hospital be funded by a private finance initiative, which the local people and the primary care trust do not want?
Ms Blears: As the hon. Gentleman knows, extensive local discussion has taken place about re-providing excellent facilities for his constituents. The proposals are for a new community hospital with 52 in-patient beds, rehabilitation facilities, out-patient, diagnostics and X-ray equipment, a pharmacy, a minor injuries unit, a renal satellite dialysis unit and, I hope, a maternity unitall under Labour. The hon. Gentleman asks whether the hospital will be funded by a PFI or by traditional procurement. He wants the money and the investment, so I am pleased that on his website he said that the Budget was good for the NHS. If that is the case, why did he not vote for it?
Jim Knight (South Dorset): My hon. Friend will be pleased to know that the future of the cottage hospital in Swanage is secured, following the opening of a day surgery unit there in the past 12 months. However, the lack of decent, affordable public transport for patients and visitorsespecially from rural areasto that hospital remains a problem. What steps are her Department and others taking to improve that situation?
Ms Blears: My hon. Friend is right. Providing care closer to home means that patients and their families need to be able to reach facilities as quickly as possible. We have a project that is examining transport across the board to see how we can get people to out-patient and diagnostic appointments. Perhaps we need a revolution, with
Mrs. Ann Winterton (Congleton): I support the case put forward by my hon. Friend the Member for Lichfield (Michael Fabricant) for cottage hospitals and their funding. Is the Minister aware that the Congleton and District War Memorial hospital was funded by subscriptions from people who paid a penny a week from their wages, that we have fought closure on more than one occasion, that the services at that much valued local facility have changed over the years and that local people want it to continue? Will she give her support to the health authority for the hospital to continue to provide services for all local people?
Ms Blears: I am delighted that the hon. Lady's constituents treasure and value that hospital, which is part of their NHS. It is important that we have a wide variety of services, including acute trusts and local cottage hospitals. As the NHS develops, so the role of cottage hospitals will become more important in providing recuperative care, day surgery facilities and a range of new ways of delivering services. That is why the new investment is important, together with the reforms, so that the hospitals continue to have a vibrant role to play. I am not aware of the specific details about Congleton, but I shall respond to the hon. Lady in writing. However, she must recognise that for her hospital to be maintained, she has to approve the extra investment going into the service.