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Mr. Jim Cunningham (Coventry, South): Is my right hon. Friend saying that the new structures will replace the trusts?

Mr. Milburn: Yes, in a word. As we said in the NHS plan, the more performance improves, resources bite and reform takes hold, the more autonomy will be earned throughout the health service. This is a big change, but I believe it is the right change.

That brings me to the final measure in the Queen's Speech, the delayed discharges Bill. I believe that we owe a duty to today's generation of older people, because it was they who built and sustained public health and social services in our country. They deserve dignity and respect in old age, but being trapped in hospital when they want to be cared for at home denies them both. Delayed discharge from hospital is a serious problem. Since we put in an extra #300 million last year to deal with it, rates have fallen by more than 20 per cent., but even today, 5,000 older people are needlessly in hospital when they are ready to leave.

The Community Care (Delayed Discharges etc.) Bill, which we have introduced today, brings fundamental reforms to deal with that problem once and for all. Under the current system, for as long as the elderly person remains in hospital, for good reasons or bad, they remain there at the cost of the national health service. Under the new system, when the patient is ready and able to leave hospital, the cost will pass to social services. Where social services fulfil their responsibilities, we will look to give them extra rewards. Where they do not do so, they will have to pay the hospital for the costs that it incurs in providing care for the patients.

The interests of older people are not served by a blurring of responsibility. The costs of care should fall where they belong. The Bill will help to ensure that the money that we have made available to social services is spent on them, so that capacity can be built up and not cut.

Mr. Stephen Pound (Ealing, North): I am very grateful to my right hon. Friend for giving way. A decent, well-performing social services authority such as the London borough of Ealing will find itself being charged #2.2 million a year, on its anticipated figures, through the #120-a-night charge, because of forces beyond its control. I am sure that he has considered the fact that, in many cases, the beds that are needed to move people away from hospitals providing acute care are simply no longer available in the community.

Mr. Milburn: I understand the capacity problem, but we will again have a problem if we think that the only way of caring for older people is placing them in residential care homes. Of course, the care homes sector is extremely important, but it is worth listening to what older people themselves say about where they would like to be cared for. Overwhelmingly, they would prefer to be cared for not in a care home, but in their own home.

I understand the difficulties in different parts of the country. That is precisely why we provided in the Budget for a doubling of social services investment from

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this year to the next. That is not a 5 or 10 per cent. rise, but a doubling in the resources available to social services. However, social services must fulfil their responsibility. If my hon. Friend the Member for Ealing, North (Mr. Pound) stops to think about it, he will recognise the current problem. The hon. Member for Woodspring may stand up in a minute and say that what is happening is all about fining social services, but I disagree with that language. If he wants to use it, I say to him that social services are effectively fining the health service, because the costs are incurred in hospital, which cannot be right. Partnership works only when the health service and social services each accept their responsibilities, so we need an incentive for them to do so. That is what the Bill provides.

The reform programme set out in the Queen's Speech draws on the traditions of social and community ownership that I believe inspired the founders of the national health service. It sticks firmly to the principles on which the NHS was founded, but places a new premium on local accountability for local services. Reform cannot be achieved by holding on to the structures of the last century; it has to be shaped by the expectations of this century. Reform means investing not only extra resources in front-line services, but power, trust, ownership and control.

We on the Labour Benches have had the courage to raise the resources; we must now have the courage to make the reforms.

2.23 pm

Dr. Liam Fox (Woodspring): W. H. Auden once said that

Xpropaganda is a monologue that seeks not a response but an echo."

Sadly, for too long in the Government's approach to health, propaganda rather than substance has been the main currency. That is a very useful ploy when it is advanced by someone as plausible as the Secretary of State, but rather than getting a rational analysis of the current state of health care in the United Kingdom, we tend to be bombarded with statistics that too often seem to patients and medical professionals to belong to some sort of parallel universe rather than to Britain's NHS in 2002, the Labour party's sixth year in office.

As was obvious in the Secretary of State's remarks about foundation hospitals, the Government seem increasingly to make up policy as they go along in a series of knee-jerk reactions that occur when they are worried about their lack of delivery. Before we drug ourselves on yet more Government promises, let us take a rational view. We can see the clarity of thought and the intellectual cutting edge that Labour brought to health policy when it was elected in 1997 by looking at its manifesto. Indeed, it is very clear:

XNew Labour is a party of ideas and ideals but not of outdated ideology. What counts is what works. The objectives are radical. The means will be modern".

That is the sort of psychobabble that we have all become used to in recent times. The manifesto says that Labour

Xwill not return to the top-down management of the 1970s".

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[Interruption.] There is no point in Front Benchers shouting; they can make their point later. The manifesto also says:

XThe key is to root out unnecessary administrative cost, and to spend money on the right things".

It goes on to say:

Xunder the Tories, the administrative costs of purchasing care have undermined provision and the market system has distorted clinical priorities. Labour will cut costs by removing the bureaucratic processes of the internal market."

So has Labour returned to top-down management, cut administrative costs and dealt with distorted clinical priorities? When it came to power, there were 190,000 beds in the NHS; now there are 186,000—a reduction. There were 173,000 administrative staff; now there are 188,000—an increase. We now have more administrators than beds. When Labour came to office, the cost of administering the NHS was #270 million; the projected cost of administration for 2003–04 is #360 million—an increase in cost.

What about distorting clinical priorities? In the wake of the recent story that a senior surgeon at St. George's hospital in London had been told not to accept urgent surgical referrals from outside the London catchment area, the BMA warned that the performance targets had a distorting effect on clinical priorities. It said:

XThis is a stark example of the perverse pressures which waiting list targets can create. Of course we want patients needing routine surgery to be treated promptly, but this must not be at the expense of life saving surgery for patients with complex injuries."

If the concept of the NHS is to have any practical meaning, surgeons with highly specialised skills must be able to offer their expertise outside the narrow catchment area of their own hospitals. However, the Government's centrally driven ideals are interfering with delivery locally and, worse, interfering with clinical priorities.

The problem for the Labour party is that, for far too long, it has believed its own propaganda. Essentially, its message in 1997 was, XThere is nothing basically wrong with the NHS; if only those wicked Tories would spend more money on it." For five and a half years, they have therefore thrown more money—billions and billions of pounds—into the NHS, but what do we have in return? Despite a 10.8 per cent. funding increase between 1998–99 and 2001, hospital admissions have risen by only 0.9 per cent, as has been pointed out. Finished consultant episodes have risen by 2.3 per cent. The Secretary of State spoke about the maximum waiting time for a coronary bypass, but the average waiting time for a coronary artery bypass graft is now two weeks longer and there are still more than 1 million people on the waiting list. Some 80,000 fewer people are receiving domiciliary care. Emergency readmissions are increasing and have risen by 23,000 in the past two years. The Audit Commission, which is hardly an organ of the Conservative party, stated that in 1996, 73 per cent. of hospital patients in accident and emergency were seen by a doctor within an hour. That figure has now fallen to 53 per cent. Similarly, 90 per cent. of patients were admitted within four hours, but that has now fallen to 76 per cent. Some 60,000 fewer care home places exist than when Labour came to power in 1997.

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Those are the things which are causing the real difficulties for patients and which the Secretary of State is trying to get away from. Perhaps worst of all, 77,000 operations were cancelled last year—a 54 per cent. increase on 1997–98.

How can it be that such a big funding increase is taking place while things are getting so much worse at the front end? That is the question that the Secretary of State has to ask. If the public could ask one question, it would be: XWhy is it that, with all this spending, our hospitals are so dirty?" It is this Government's sixth year in office, but 5,000 patients a year will die of the infections that they contract while they are in hospital. That is the equivalent of three Clapham rail disasters a week, which puts things into perspective.

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