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Steve Webb: I am grateful, as my remarks apply to what the Secretary of State has just said. Is she not in danger of falsely raising public expectations by using the language of taking waiting out of the NHS? Even by her own terms, it will be more than two years before she believes that she can deliver an 18-week wait. Is it not misleading to raise expectations more than two years in advance and to get that vocabulary, as new Labour always does, in currency now? Do not her own figures this week show that more than 40,000 people are waiting more than a year just for diagnosis? Are we not an awfully long way from the period when the Secretary of State should start using those phrases?
Ms Hewitt: The hon. Gentleman is absolutely right about the number of people who are still waiting too long for diagnostic tests. Last year, we introduced choice in respect of where people can go for CT scans or MRI scans, for example, if the NHS could not treat them within six months. That has already helped to bring down the waiting times for diagnostics, but what I want to know from the hon. Gentleman is whether he supports us in trying to get rid of the excessive waiting times. We promised in the manifesto on which we were elected last year to move from an 18-month wait for an operation to just 18 weeks from GP referral to the operation. That means making further changes and improvements to the NHS to ensure that people do not have those unacceptable waits for diagnostic tests.
Mr. Mullin: My right hon. Friend is right to draw attention to the significant achievements in the health service over the past 10 years, but does she acknowledge that one destabilising and demoralising factor for many who work in the NHS has been the constant stream of centrally imposed initiatives and demands for the redrawing of boundaries? Can she promise a period of calm in the period ahead, as it is still a source of great disturbance, even among the best-run health authorities, in which I include my own?
Ms Hewitt: In terms of the changes to primary care trusts and strategic health authorities over the past year, I most certainly can promise my hon. Friend such a period of calm. Indeed, I would like to take the opportunity to pay tribute to the leadership of SHAs and PCTs, who are doing a superb job in leading the NHS and securing those further improvements.
For far too long, mental health services were neglected. We have changed that. Less than 10 per cent. of the NHS budget used to be spent on mental health, but now it takes a much bigger share of a far bigger budget. There has been an increase of almost £1 billion in the past five years alone. Again, we are talking about investment matched by reform. In almost every part of the country, when I meet mental health staff and the users of their services, I hear about a transformation in the way in which those services work. Fewer people are cared for in acute hospital wards and far more people are looked after in the community. Painfully vulnerable people and their families are benefiting, with suicide rates at their lowest since records began in Victorian times.
Tim Loughton (East Worthing and Shoreham) (Con):
I wonder whether the Secretary of State will qualify those figures about the share of spending in the
NHS going on mental health. My understanding is that spending on mental health in 1997 accounted for around 14 per cent. of the NHS budget; now it accounts for around 11.5 per cent. and has been growing more slowly than the rest of the NHS. That sends out a bad signal and points to the fact that mental health services remain a second class citizen in the NHS.
Ms Hewitt: I do not recognise either the hon. Gentlemans figures or his characterisation of the services. Although I would be the first to say that there is a great deal more that we need to do to improve and expand mental health services, I wish that he would acknowledge the quite outstanding work of staff in mental health services and the transformation that they have made.
The mental health Bill that was announced in the Queens Speech, and which is introduced in another place today, will help the NHS to build on those achievements. Hon. Members are only too aware of the problem of those mental health patients who are treated in hospital and whose condition improves with care and medication, but who leave hospital and then fail to keep up their treatment. In a small minority of cases, involving some of the most seriously ill people, that can lead to terrible and tragic results.
Mr. Burns: Notwithstanding the importance of funding and the transformation or otherwise of services, there is another critical aspect to mental health that needs to be addressedreducing the stigma and the fear of mental illness and mental health patients. What more can be done to help to break down the barriers of fear and the stigma associated with mental health?
Ms Hewitt: I know that the hon. Gentleman feels strongly about such issues and his point is important. That is why we have already put in place a campaign to try to reduce the stigma that affects people with mental health problems and in particular to change the attitudes of employers. We are working with a number of business organisations on that very issue.
The mental health Bill will provide for supervised community treatment for certain patients after they have been detained in hospital, ensuring that they comply with treatment and enabling action to be taken to prevent relapse. The Bill will also strengthen human rights protection and introduce new safeguards for people who lack the capacity to make a decision for themselves and who are deprived of their liberty, but are not subject to mental health legislation.
We shall also publish in this Session a draft Bill to establish a single regulatory authority for tissue and embryos, and to ensure that our law on human fertilisation and embryologywhich is already one of the best in the world and is widely acknowledged as suchcontinues to provide the right ethical framework as medical technology develops.
Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): On providing mental health care in the community so that people in crisis do not have to be admitted to mental health institutions, my right hon. Friend will be aware that I drew her attention to the recommendations that the Sainsbury review made to the Milton Keynes General PCT on reforming its mental health services. The PCT has implemented some of those recommendations, but not enough to be able to provide a 24-hour crisis service. Will my right hon. Friend reiterate to the PCT the benefits, in both service and efficiency, of providing that crisis service, so that people receive treatment and do not have to be admitted, which is less satisfactory and more expensive?
My final point about health and the Queens Speech is that because public engagement in local NHS decisions is so important, we shall seek an early legislative opportunity in this Session to build on the work of patient and public involvement forums, with the creation of new stronger local involvement networks.
Mr. Lansley: The Secretary of State will recall that, before the 1990 embryology legislation was introduced, the then Government made it clear that at all stages it would be subjected to a free vote. I know that many hon. Members were disappointed that this Government chose to whip the regulations relating to donor anonymity for sperm and eggs, rather than leave it to a free vote. Will she give a commitment today that the legislation on embryology will, like the previous legislation, be subject to a free vote?
Ms Hewitt: I have not had an opportunity yet to discuss that with my colleagues. I had better not anticipate those discussions. For this Session, it is a draft Bill, but the hon. Gentleman makes an important point about the need for free votes in this House on such matters.
The dramatic changes that are taking place in medical science and technology are only part of the far larger changes that are creating a knowledge-driven global economy. When the 3.4 million unskilled jobs we have in Britain today will shrink to about 0.5 million by 2020, and when China and India are producing 4 million graduates every year, we must do far more to ensure that every man and woman in our country has the skills and the confidence to earn a living and to lead a fulfilling life.
It is extraordinary that, in yesterday's debate, the Conservative and Liberal Democrat leaders scarcely mentioned the economy and the importance of education. As we announced in the Queens Speech, we are introducing a Bill to reform the further education
sector, which already does so much to help people to learnoften, people who had few opportunities in their earlier lives. It will streamline and modernise the Learning and Skills Council, ensuring that it works even more closely with employers, learners and regional development agencies. It will develop foundation degrees and create the powers that are needed to improve further education provision where that is not yet good enough. I am sure we will have lively debates on those important Bills.
Before I finish, I want to say a little more about investment in public services. The Conservative party likes to complainit has done so again todayabout NHS funding and particularly about the funding formula, but what is its alternative?
In our debate a few weeks ago, I quoted from the Tories' campaign handbook, which complained on page 18 that parts of Bedfordshire were getting less money than parts of Manchester. My hon. Friends will remember that I accused Conservative Members of wanting to take money from poorer, sicker communities to give to healthier, wealthier neighbourhoods. I fear that I may have been unfair to the Conservatives. I may have misrepresented their policy, because it turns out now that they want
the most NHS resources to be given to those areas where the disease burden is highest.
That sounds fair enough, does it not? We should all be able to agree on that. Well, I have investigated what would happen if NHS funding were based solely on the burden of disease and took no account of past funding levels, the existing provision of services or even of the age of the population in a particular area. What I found surprised meand it may surprise Conservative Members as well.
The hon. Member for South Cambridgeshires local NHS, thanks to the record investment that we are makinginvestment, of course, that he voted againstnow receives over £1,000 for every man, woman and child in his constituency. But what puzzles me about his position is that, under his proposals, based on the burden of disease, his constituents in the city of Cambridge would actually lose £205 each of NHS funding, a cut of 20 per cent. and a total loss to the local NHS of nearly £24 million. Has he told his constituents yet what he is proposing? I think they ought to know.
I wonder whether the hon. Gentleman has told his constituents that, under his proposals, my constituency, which is already funded at £1,300 a head, having greater health needs than South Cambridgeshire, would gain another £305 per person, a total gain in Leicester of £43 million. I am very grateful to him for that generous offer, but I wonder whether he has explained to his Front-Bench colleagues that, under his proposal, every one of them would see NHS funding in their own constituency cut and every one of my ministerial colleagues would see funding in our
constituencies rise. I hate to disappoint my hon. Friends but, tempting though it is, we will not adopt the hon. Gentlemans policy for the simple reason that we believe in fairness for everybody. We believe in more money for the health service everywhere, but with the biggest growth for places with the greatest needs. We can do thatgrowth of 8 per cent. this year and next year everywhere, but even faster growth in the places that need it mostonly because NHS funding is growing faster than ever before. It is time that the Conservatives stopped complaining about funding, especially as they voted against the national insurance contributions that made the funding possible in the first place.
As we learned in yesterdays debate, the truth is that the Conservative party is in a complete mess on policy. The Opposition cannot decide whether they want more money for Bedfordshire and less for north Manchester, which is what they tell the people of Bedfordshire, or less money in Bedfordshire and more in Manchester, which is what their policy would actually mean.
That muddle is no accident; it is the direct result of a Tory party that does not know what it believes in, and of a Tory leader who thinks that nobody will notice if he says one thing to one audience and something completely different to another. He is trying to pretend that he would give the NHS more money, when he and his party colleagues voted against the increased funding, and when his partys economic policy would mean that there is less money, not more, for public services. He is trying to pretend that he supports NHS staff, when his shadow Chancellor has said that he would rip up the agreement that we have reached with staff on public service pensions.
Anybody who listened to yesterdays speech by the right hon. Member for Witney (Mr. Cameron) could reach only one conclusion: he is a lightweightquite pretty, I grant, but a lightweight all the same. He does not begin to understand the scale of the challenges we face, and he cannot, and will not, make the difficult decisions that it is necessary to make in order to rise to those challenges.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful for this opportunity to open for my party the day of the debate on the Address that is about education and health. We chose those subjects because education and health, and the improvement of our public services, are our partys priorities. In the Queens Speech of May 2005, it was stated that education was the Governments main priority, but it disappeared in the briefing, and it has completely disappeared this year; it is off the radar screen. Health is the number one priority for us; the Leader of the Opposition has made that absolutely clear. What price security, if we cannot be sure that our NHS is there for us and our families when we are ill and in need? What price hope, if we do not have the hope of high standards in education that people can rely upon?
Those are our priorities, but they are not expressed in this Queens Speech. In this Gracious Speech, written by this Government, education has disappeared
off the radar screen, and so have expressions of priority for health. That is very curious. We have heard time and againin business questions, as well as in interventions on the Secretary of State todaythat people working in the national health service are worried about the loss of services, about their jobs, about the loss of confidence and morale across the service, and about where they are going and what the future holds for them. There was nothing in the Queens Speech about any of that.
There was also nothing in the speech about the fact that, since the last Queens Speech in May 2005, gross deficits of £1.3 billion have been announced for the previous financial year in the NHS, and just last week the Department of Health was forced to admit that the gross national health service deficits in the current financial year are now predicted to be £1.2 billionand, worryingly, the Department has admitted that the number of NHS organisations in deficit is approaching the same number as were in deficit last year. Is there any indication in the Gracious Speech that the Government propose to respond to that, and to the concerns to which it gives rise? No, there is not.
Mr. Henry Bellingham (North-West Norfolk) (Con): My hon. Friend has touched on the subject of deficits, but is he aware that the new Norfolk and Norwich primary care trust is starting off with a staggering debt of £50 million? We have already heard that the Queen Elizabeth hospital, in my constituency, will not carry out any non-urgent operations during next February and March. Surely the Government should allow the new PCTs to start without these staggering deficits.
Mr. Lansley: Yes, I understand exactly the point that my hon. Friend makes. It is in his and my regionthe east of Englandwhere the relative deficits are greatest, and the consequences will be very severe.
Sir Nicholas Winterton (Macclesfield) (Con): I thank my hon. Friend for giving way. I am sad that the Secretary of State did not give way to me, as a past Chairman of the Health Committee, because I wanted to ask a very relevant question. Are not many of the deficits due directly to Government policy on payment by results? If hospitals are being much more active in dealing with patients and cases, and the Government and PCTs have underestimated the amount of activity that hospitals can carry out, is it not up to the Government to respond by saying to hospitals, You cant carry out the number of operations that you currently do, because we cant afford it? It is not the fault of hospitals, doctors or nurses; they are responding to Government policy.
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