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14 Nov 2002 : Column 168—continued

Mr. Edward Garnier (Harborough): Will the Secretary of State remind me which year of the 10-year plan we are in?

Mr. Milburn: I think that I answered questions from the hon. and learned Gentleman when I introduced the plan in the House. We published it in July 2000, so I think that he can work out where we are.

Mr. Frank Dobson (Holborn and St. Pancras): Not without a fee.

Mr. Milburn: I am grateful to my right hon. Friend—at least, I am at this stage.

Sometimes, people in this country pretend that we are the only ones having to confront change—that our health care system is the only one to face changes in demography and an ageing population, the enormous possibilities but new pressures brought by new drugs and treatments, and the rise of a more consumerist set of

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public expectations. However, those waves of change are washing over every health care system in the world. That is why health care reform is at the top of the political agenda in almost every developed country.

The NHS is in a better position than most to confront those pressures. In a world where health care can do more but costs more than ever before, it is an enormous strength to have an NHS providing services that are free, and based on need, not on ability to pay.

The NHS provides what some call the security—what Nye Bevan called the Xserenity"—of knowing that we all pay in when we are able to do so, so that we can all take out when we need to. The health of each of us depends on the contribution of all of us. That is the great strength of the NHS. Those values and principles are as strong for Britain today as when the national health service was first formed.

We must be honest, however; there are weaknesses, too, in the organisation of the NHS. In 50 years, health inequalities—the gap between rich and poor in terms of health outcomes—have widened rather than narrowed. Figures released by the Office for National Statistics just last week show that a boy born today in Manchester will live on average ten years less than a boy born in Dorset.

Uniformity in provision has not produced equality of outcome, nor has it produced equality of opportunity. Too often, the poorest services are in the poorest communities. If we want an NHS that is more tailored to the needs of local communities and more attuned to different local problems of poverty and deprivation, we have to move away from monolithic services and centralised control.

Different communities have different needs.

Mr. Paul Goodman (Wycombe): Will the right hon. Gentleman give way?

Mr. Milburn: In a moment.

Overall, levels of infant mortality in our society are falling—thankfully—but in some of the poorest sections of society they are rising. In parts of London, 100 languages are spoken, which puts pressure on the NHS. In a city such as Bradford, the incidence of heart disease among Asian men and women makes the work of the NHS there different from its work in other parts of Britain. Fairness rightly demands that standards in heart or cancer services should be broadly the same in one part of the country as in another. That is why we have put in place a national framework of standards.

Mr. John Bercow (Buckingham): Given that one of the weaknesses of a national pay bargaining system is that it inevitably fails to take into account higher costs of living in parts of the country where there are staff shortages that we need to tackle, will foundation hospitals have absolute discretion and control over pay? If not, how and to what extent will that freedom be circumscribed?

Mr. Milburn: I will deal with foundation hospitals in general in a moment, but pay is a very important question, and not only for those hospitals. Today, NHS trusts have discretion and have had it for many years.

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Indeed, many exercise it. When trusts are recruiting an anaesthetist or a nurse, there will often be an element of local discretion in their pay.

As the hon. Gentleman is aware, we are negotiating with the trade unions that represent the 900,000 health workers—nurses, porters, cooks, cleaners, scientists and technicians and so forth. This is the fourth year of our negotiations for what we call the agenda for change pay system. Those negotiations are going well. I hope that we can reach fruition before too long. At their heart is the simple idea that in a national system in which people rightly demand equity we need a broad national framework for pay so that people have some certainty about the sort of pay that they are likely to receive. However, as the hon. Gentleman and all right hon. and hon. Members know, different parts of the country have different housing and labour market pressures, so there needs to be some local flexibility in that national framework. That is what we need—a national framework and some local discretion.

I expect the first generation of NHS foundation hospitals as well as subsequent generations to want to take on board the agenda for change agreement, provided that we can reach it. They will therefore be able to exercise discretion and flexibility, but there will be a broad national framework too. We will see where we get to with the negotiations. I am not pre-judging the outcome and there is clearly some way to go, but we are making progress.

Dr. Brian Iddon (Bolton, South-East): I am pleased about my right hon. Friend's statement on dealing with constituencies with real health need. He will know that I have been campaigning for five years on behalf of my constituency, which started second from bottom in terms of being furthest from target. Although we have had a lot more money—I praise the Government for delivering that—we are still in that position relative to all other health authorities. Will he assure my constituents that we will target the real need that exists in certain constituencies—for example, in Manchester, which he just mentioned?

Mr. Milburn: I cannot assure my hon. Friend about that particular case. As he knows, the formula is still under review. However, when we make allocations to primary care trusts later this year, those will be based on a new formula that will give greater recognition to the problems of health need and health inequality of which he is all too painfully aware—and so am I. We have to get the balance right between recognising that there are different labour markets and different pressures, which the hon. Member for Buckingham (Mr. Bercow) mentioned, and acknowledging that there are different health needs and big health inequalities. The formula will need to address that balance.

Mr. Dobson: Will my right hon. Friend confirm that after the 1997 general election we found that places such as Bolton and Tower Hamlets were far behind the notional sums to which they were entitled under the national formula, whereas Surrey, for example, was far in advance of its notional sum?

Mr. Milburn: My right hon. Friend's memory is serving him extremely well. That is precisely the case

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and, as he knows, in the past couple of years we have adjusted the formula to recognise, first, that the current formula does not properly respect the health needs of different local communities—parts of Greater Manchester and the surrounding areas, for example, have benefited from that change—and secondly, that we also face labour market pressures in different parts of the country. Incidentally, those pressures are not confined to London. We made those adjustments pending the full-scale review of the formula.

Dr. Jenny Tonge (Richmond Park): Is the Secretary of State not being rather stupid himself in assuming that the inequalities of health in the population are due solely to the provision of health care? Surely they are as much to do with poor housing, environment and education, which are also the responsibility of the Government.

Mr. Milburn: I am almost deeply wounded by the hon. Lady's accusation. [Interruption.] The party of the vulnerable knows how vulnerable I feel.

The hon. Lady is clearly right to say that there are background causes for health poverty. Poverty is one, poor housing another and a bad environment a third.

Mr. Eric Forth (Bromley and Chislehurst): And lifestyle.

Mr. Milburn: The right hon. Gentleman is right; lifestyle is another issue. However, the hon. Lady is wrong in one fundamental respect. My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), who intervened earlier, could also have said that when we considered these issues, there was inequality not only in outcomes but in access to service. People in the better-off parts of Leeds, for example, have three times the access to heart surgery that those in the poorest parts have, despite the fact that the incidence of heart disease is higher in the poorest parts.

That is because there is, unfortunately, an iron law about the provision of public services. People who are more articulate and better off—the middle class—tend to do better out of the public services than working-class people. We must put that right. I do not believe that national standards or uniformity of provision will, on their own, necessarily address the very different problems in various communities. National standards are beginning to deliver results to reduce unfairness in areas such as cancer, heart disease, care of the elderly and mental health. In the next few weeks, we will publish similar plans to improve diabetes services.

While I am on the subject of mental health, let me say that we will press ahead with reform of the mental health laws. The laws today are rooted in the 1950s. We need to strike a better balance between safeguarding the rights of individual patients and protecting both patients and the public. The draft Bill that we issued for consultation, after we had consulted following a Green Paper and a White Paper, has produced around 2,000 responses. When we have finished considering them, we will bring forward the Bill during this Session.

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