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Lembit Öpik (Montgomeryshire): Is the hon. Gentleman saying that he agrees with the Opposition parties in the Assembly, which today voted down Labour's proposals for a so-called action plan on the ground that they did not think that it was anything of the sort, with regard to the Wanless report? Would he acknowledge that, for all his criticisms, many of which I agree with, it is Labour Administrations in Cardiff and in London who are presiding over the circumstances in which many of our constituents—including mine, near the border—can get no serious medical attention from the hospitals across the border because the bills cannot be paid?
Gareth Thomas: There are real difficulties in border areas. The hon. Gentleman has made a fair point. We must accept, however, that the Assembly is making some progress. It has inherited a difficult situation.
Mr. Jon Owen Jones (Cardiff, Central): My hon. Friend should not allow that intervention by the hon. Member for Montgomeryshire (Lembit Öpik) to pass without remarking that during the major period of difficulty in implementing change, the Labour party in the Welsh Assembly was in partnership with the Liberal Democrats—
Mr. Deputy Speaker (Sir Michael Lord): Order. This Adjournment debate is obviously quite delicate in the way that it deals with a balance between this House and other establishments. I do not think that we should get too involved in the internal politics of the Welsh Assembly.
Gareth Thomas: The burden of my debate is that the pace of change and reform must accelerate if we are going to turn round the NHS in Wales. I am particularly concerned about the need to ensure that there is more capital investment in the NHS. There is an urgent need to invest in buildings, equipment, new technology and new services, and I should also like to see the Assembly take on the idea of diagnostic and treatment centres and large-scale methods of dealing with cataract operations, knee joint operations, and so on.
There has been cumulative underinvestment, and let us make no bones about the fact that the Conservatives were responsible for that. In commissioning its national estates strategic framework, the National Assembly for Wales demonstrated that it recognised that there was a huge challenge involved in addressing what are called backlog maintenance costs. These are the costs necessary to bring the NHS trusts' estates up to a reasonable standard. A recent report by the Auditor General for Wales showed that 32 per cent. of the NHS trusts' estates surveyed were unfit for their purpose. A conservative estimate of the cost of meeting those backlog maintenance costs is no less than £431 million. That does not include the investment in new services such as diagnostic and treatment centres that I believe should take place, to allow us to catch up with the pace of technological reform in the NHS.
The Assembly appears to recognise that there is a role for the private finance initiative, and we are told that there is no ideological objection to its take-up. It is worrying, however, that while PFI projects are being taken up at a very fast rate over the border in England, and many new facilities and hospitals are being built in places close to my constituency such as Liverpool and Manchester, the take-up in Wales is disappointingly low. It is difficult to avoid the conclusion that there is an ideological objection to it.
Albert Owen (Ynys Môn): My hon. Friend mentioned hospitals in Manchester and Liverpool. The NHS trust in my area of north-west Wales is meeting its targets, and one of the reasons for that is that many patients go to those hospitals in England. Does he agree that the NHS needs to maintain such cross-border co-operation and partnership so that waiting lists in Wales can be substantially reduced?
Gareth Thomas: I could not agree more with my hon. Friend. Of course, that traffic of people and patients across the border is a feature of the NHS in Wales.
I am afraid that there is a lukewarm approach to the PFI, but I believe that it is essential to take it up.
Adam Price (East Carmarthen and Dinefwr): If I may say so, the hon. Gentleman has given us an expert diagnosis of the problem, particularly in relation to the lack of capital investment. What I am not so convinced about is the prognosis. For example, would it not be more cost-efficient for the UK Government to allow the Welsh Assembly Government to borrow on the bond market rather than use the PFI, which is a rather expensive way to generate capital investment?
Gareth Thomas: I do not accept that point, but there is a real need to ensure that we work in partnership with the private sector to release extra funds over and above the generous allocations made available by this Government through their prudent handling of the economy. That is my point. If we are to create a modern health service, we need more take-up.
If we are to safeguard the future of the NHS, it must become not only a comprehensive service, free at the point of need, but a truly modern service that is genuinely responsive to patients' needs. The Prime Minister is quite right to emphasise the fact that reform must accompany investment. As a strong supporter of devolution who campaigned strongly for a Welsh Assembly, and one who is proud of that achievement, which the Labour Government managed to implement, I say that it is essential that the Assembly demonstrates to the people of Wales that it can discharge this responsibility to the people of Wales and create a national health service fit for the 21st century.
9.7 pm
The Parliamentary Under-Secretary of State for Wales (Mr. Don Touhig): I congratulate my hon. Friend the Member for Clwyd, West (Gareth Thomas) on securing this useful debate, which gives us the opportunity to discuss the considerable investment in the NHS in Wales.
Labour Members are committed to securing improvements in the NHS in Wales—a commitment that we share with the Labour-led National Assembly. Like my hon. Friend, I believe that the twin engines that will drive forward the essential improvement in the NHS are investment and reform—investment supporting a reform agenda tailored to Welsh health needs.
The Government and the Assembly, working in partnership, are providing record investment. Planning and delivering reforms is an essential part of that. Investment in the health service in Wales has never been greater. The Assembly's recently published draft budget for next year will see an 8.9 per cent. increase in health and social care spending and a total health budget of £4.28 billion. The trend of decades of underinvestment has been reversed. Perhaps that is why the Opposition decided not to show up this evening.
Investment means building for the future so that the NHS in Wales—one of our proudest achievements of the 20th century—goes from strength to strength in the 21st. We are laying foundations for the NHS in Wales that will deliver a world-class health service. Some of what we are doing is, literally, building, and the people of Wales see the results around them—for example, the Royal Glamorgan hospital in Llantrisant, St. David's hospital in Cardiff, Chepstow community hospital and the new Neath and Port Talbot hospital.
Since 1999, the Labour-led National Assembly has built those four hospitals as part of delivering the pledge of 10 new hospitals within the next 10 years. That is in addition to the all-Wales capital programme projects.
Mr. Jon Owen Jones: Will my hon. Friend comment on the fact that three of the four hospitals that he has referred to were built under the PFI and commissioned before the Welsh Assembly came into being?
Mr. Touhig: That is an example of the partnership between Government and the Assembly to which I referred. I will comment on the PFI in due course.
The all-Wales capital programme includes refurbishing many community hospitals in Powys, major health and safety work at Prince Charles and Glan Clwyd hospitals and the re-provision of mental health services in Pembrokeshire and Carmarthenshire.
Some of my hon. Friend's comments have naturally focused on PFI projects. Nye Bevan used to say that policies needed to be reviewed because they became blunted with use. The PFI is one new tool that we can use. It was not available to the founders of the NHS, but it is available to us. It can be used for capital investment in the health service. I support the PFI, and commend its use whenever that is considered appropriate.
Of course, our greatest asset in the NHS is not any one building or facility, but the staff who work in it. The Assembly has been investing heavily in the men and women of the NHS in Wales. The number of front-line staff has risen as a result of increased investment, and of the successes of the recruitment and retention strategies applied by the Assembly. There are 30 per cent. more
whole-time equivalent hospital consultants working in Wales than there were in 1997. There are nearly 16 per cent. more qualified nurses than in 1997, a 5 per cent. increase on last year, and there are 6 per cent. more GPs than there were a decade ago. But the recruitment of extra health professionals is not enough on its own. Our colleagues in the Assembly have policies for retaining the expertise that we already have in Wales.The last Government—not represented here tonight—cut the number of doctors and nurses being trained. Over the last three years the number of medical students has increased from 966 to more than 1,100, and it will increase to 1,385 by 2004. The Assembly plans to have 700 more consultants and GPs, 6,000 more nurses and 2,000 more other health professionals by 2010.
All that effort is aimed at improving the way in which we treat people who are already ill, but we have another fundamental task: to tackle the long-term health problems that affect our communities. As well as investing in the fabric and staff of the NHS, the Assembly has invested, and continues to invest, in that effort. It is vital for most help to be targeted where it is most needed. The draft budget to which I referred has targeted funds on tackling health inequalities in Wales.
For me, the most important person in the NHS is the patient. Investment and reform in the NHS should have one simple objective—to meet the needs of the patient. The patient must come first. That is why we are not satisfied with our present record of investment. We must reform the health service in Wales so that it does an even better job in meeting the needs of Welsh patients.
Structural reform of the NHS in Wales has focused on the creation of strengthened health services, and seeks local solutions to local needs. Standards are set at an all-Wales level, but are delivered locally. Both the Government and the Assembly believe in empowering local communities to decide how best to tackle local health problems. Local health boards and local authorities now have structures to allow closer working between the NHS and social services that can deliver better care for patients. That partnership approach is integral to delivering better care for patients. Our shared aim is a seamless provision of services, delivered through groupings of heath and social care providers.
The patient is rightly at the centre of the NHS. In 2001–02, 200,000 more patients were seen in Wales than in 1996–97. The health service in Wales treated 643,000 in-patients, and dealt with 2.8 million out-patient appointments last year alone. That is an impressive record, but we have another important commitment—to tackle the issue of waiting times, mentioned by my hon. Friend and others.
Waiting times remain a challenge, but the Assembly is tackling such challenges. Heart disease is one of Wales's biggest health problems, and one of its biggest killers. That is why the Assembly targeted cardiac surgery. When the cardiac initiative began in July 2001, 100 patients were waiting for longer than 12 months for surgery; now no one is waiting that long. I know from my own constituency how important orthopaedic surgery can be to people's quality of life in Wales. We inherited a huge problem with waiting times, and I am
pleased that the Assembly has targeted orthopaedic surgery for additional investment. When the orthopaedic initiative began in July 2001, more than 2,000 people were waiting more than 18 months for treatment; now there are 45, which is a considerable improvement. By the end of the year, no one will be waiting more than 18 months. Twelve months ago, 10,000 more people were waiting more than six months for their first out-patient appointment than are waiting today—again, a considerable improvement.
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