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National Insurance

7. Mr. David Amess (Southend, West): What estimate he has made of the cost to the NHS of the increase in national insurance contributions announced in the Budget. [52778]

The Secretary of State for Health (Mr. Alan Milburn): I estimate that the changes to employers' national insurance contributions announced in the Budget will cost the NHS about £200 million in 2003–04.

Mr. Amess: I still think that we will have to scrutinise that figure carefully. Will the Secretary of State provide an estimate of the increase in national insurance contributions for senior house officers, ward sisters and consultants as a proportion of their average take-home

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pay? Will he explain carefully to the House of Commons how the increase will help recruitment and retention in the NHS?

Mr. Milburn: I have never yet met a member of staff in the health service who does not believe that the NHS needs more investment; the only people I have met who believe that are Opposition Members. I do not know whether or not the hon. Gentleman is mathematically challenged, but even if the NHS has to make £200 million worth of extra national insurance contributions, it is worth remembering that in the same financial year it will get an extra £5,500 million. Our party supported and voted for that, but the hon. Gentleman's party opposed it.

Derek Twigg (Halton): The message from my constituents is clear: they want a massive injection of extra funding in the health service, particularly in my area, where there are a lot of health inequalities. However,I am sure that my right hon. Friend will agree to look at their concern that the extra money be spent well and efficiently and that the whole service should be better managed, particularly by getting management structures in place. Are the Tories not putting up a smokescreen to try to hide their policy of privatisation, not public funding?

Mr. Milburn: I know that my hon. Friend and his constituents, like most people in this country, want to see an expanded national health service. They want more of the national health service, not less. They want more doctors, more nurses, more beds, shorter waiting times, improved diagnostic services and a cut in health inequalities. My hon. Friend is quite right about that. The only way to bring it about is to get some reforms into the NHS and to accompany them with investment.

What my hon. Friend says about the Conservatives is right. Their strategy is based on the four principles of the hon. Member for Woodspring (Dr. Fox). First, they say that the NHS is not working; then they say that it has never worked; thirdly, they say that it can never work—as a prelude to their real agenda, the fourth item, which is to get more and more people to pay for their own care. That is not the right way forward for health care in this country. What people want is a national health service treating people according to need, not ability to pay—a national health service with the right principles and the right level of funding.

Bob Spink (Castle Point): Is the Secretary of State aware that for Littlehaven's—a children's hospice in my constituency—the increase in the wage bill as a result of the national insurance contribution increase in the Budget will be well over £20,000, and that Littlehaven's is funded almost entirely by voluntary contributions, topped up by a tiny amount of grant money through the NHS? Will he increase the money that the hospice receives to compensate it for the increase in national insurance contributions, so that it does not have to sack medical staff?

Mr. Milburn: I join the hon. Gentleman in at least one respect—paying tribute to the work of the hospice movement, not just in his constituency, but throughout the country. Hospices do a first-rate job of work. We want to strengthen the partnership between the national health

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service and the voluntary hospice movement, and we want more NHS money to go into palliative care—not just into hospices, but into palliative care services more generally. That is what we want to see, and what we voted for. It is no use the hon. Gentleman coming to the House and complaining of lack of investment in the NHS or in his local hospices, if he is not prepared to vote for it. On two occasions in the past fortnight he has voted against more money for the NHS. That is what he should go and explain to his constituents.

Mr. Nicholas Winterton (Macclesfield): May I ask the Secretary of State a direct question? I fully appreciate the additional cost to the national health service of the increase in national insurance, but will he give me an assurance this afternoon that that will not prevent the Government, acting on behalf of the national health service, from encouraging the recruitment of additional midwives? I attended the Royal College of Midwives conference in Bournemouth last week, as did the Minister. There is a grave shortage in many parts of the country. If we are to provide maternity services of the quality that I believe we should, midwives are essential. Will the right hon. Gentleman assure me and the House that the increase in national insurance will not prevent the recruitment of additional midwives?

Mr. Milburn: No, I do not believe that it will. Already, the number of midwives is increasing, as the hon. Gentleman knows. He is also aware of the substantial commitment that we have given to expanding midwifery services. We expect an extra 2,000 midwives to be working in the NHS by 2004. Of course, that is partly a question of pay and making sure that people who are working very hard in the NHS are properly paid, but it is also a question of making sure that their working conditions and their working environment are right. So yes, I am confident that we will continue to recruit midwives in ever larger numbers in order to give women and families the sort of services that they deserve.

Social Services (Lancashire)

8. Mr. David Borrow (South Ribble): What recent discussions he has had with Lancashire county council concerning the provision of services for the elderly in Lancashire. [52779]

The Minister of State, Department of Health (Jacqui Smith): I met leading members of Lancashire county council on 29 April, together with some hon. Members representing constituencies in the county. In addition, the social services inspectorate has been closely monitoring Lancashire county council since it was placed under special measures in February 2000. Following the publication of the council's proposals to close a number of its care homes, the SSI is closely following the work undertaken by the council to assess its current care provision and to consult on future strategies with the NHS, local people and other interested parties.

Mr. Borrow: I thank my hon. Friend for the work that she is doing in that area. She is aware of my concern that the consultation document prepared by Lancashire county council, which recommends the closure of 35 care homes, does not include any analysis of the capacity of the

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voluntary or the private sector in Lancashire. I am sure that my hon. Friend will share my concern that on Friday last week the Galloway society for the blind in Penwortham, in my constituency, announced the closure in July of Howick house, a home for the elderly blind, which will mean that in a few months 20 elderly blind people will lose their home.

The home is currently losing £1,000 a week. Will the Minister undertake to consult to see whether anything can be done to preserve the very specialist care that is given to the elderly blind by the Galloway society for the blind in my constituency? Will she also ensure that her Department and the inspectorate take a very robust attitude to the document that the county council will eventually produce on long-term care for the elderly in Lancashire?

Jacqui Smith: I can assure my hon. Friend that the social services inspectorate is taking a very close interest in developments in Lancashire. I share his concern about ensuring that both the independent and voluntary sectors are fully engaged in any changes. Of course, that was the reason why the Government published the agreement—alongside investing £300 million in building up capacity and in reducing delayed discharges last October—which makes it very clear that we expect local authorities to work in their commissioning behaviour with the private, independent and voluntary sectors, as well as with their partners in the national health service, to ensure that we commission and develop the services that are necessary for older people.

Mr. Simon Burns (West Chelmsford): As the Minister is aware—when she is not adopting an ostrich-like approach to the problem—in the past five years, 50,000 beds have been lost across the whole long-term care sector. Is she also aware that, in the next five years in Lancashire, county council placements in the private sector will decrease by about 1,200—the number will fall from 1,860 to 600—and that 35 of the 48 council homes will close, with the loss of 700 beds? Given the pressures that that will cause in relation to placement of elderly people in long-term care, how will the Government's policy of using the stick rather than the carrot and penalising local authorities involved in delayed discharges be implemented? How will it help in tackling the serious problems that Lancashire faces with finding placements for the most vulnerable and frail in our society?

Jacqui Smith: Lancashire has already used the extra investment put in by the Government—not least the£5 million from the building capacity grant to improve services, including, for example, an 18 per cent. increase in the number of people receiving intensive home care. It is right that we build into the system incentives to ensure that our health and social services work together better, so that older people are not stuck in hospital when they would be better off in care homes, in their own homes or being supported in some other way in the community. That is why the 6 per cent. annual average real-terms increase in the next three years from which Lancashire will benefit will enable it to build the services to ensure that our older people have the right care, in the right place, at the right time. We are taking responsibility as a

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Government not only for the policy that brings health and social services together, but for the investment that enables that to happen.

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