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I have been in post for the equivalent of only 10 minutes, I suppose, but my party has been in government for 10 years, so perhaps the best way to open my speech is to look back briefly at the health service that we inherited in 1997. The service was starved of essential funding; indeed, we were investing, as a proportion of our GDP, at about the level of the Czech Republic and Poland and well below the level of France, Germany
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and Sweden. Every winter heralded a new crisis, waiting lists topped 1 million and the chronic bed shortage meant that elderly patients were turfed out in the middle of night while critically ill children were denied essential intensive care. All that has changed.

In 1997, patients were left on trolleys in accident and emergency departments for hours, or even days, waiting for admission. Now nearly 98 per cent. of patients are either admitted, transferred or discharged within four hours of arrival. In March 1997, 284,000 patients had been on a waiting list for an operation for more than six months. Today, that figure is less than 500. In 1997, half of all NHS hospital buildings had been built before the NHS was created. Now, thanks to the biggest hospital building programme ever seen in this country, it is less than a fifth.

Ten years on, the position has been transformed thanks to greater investment, difficult but necessary system reform and, above all, the tremendous work of those who work for the NHS. We have trebled the health budget and there are now almost 80,000 more nurses and more than 36,000 more doctors. Cancer death rates are down by 15.7 per cent., saving more than 50,000 lives. Death rates from heart disease are down by 35.9 per cent., saving nearly 150,000 lives. Since 2000, 231 new CT scanners and 158 new MRI scanners have been installed in hospitals.

Mr. Graham Stuart rose—

Alan Johnson: I will give way to the hon. Gentleman, who obviously wants to tell us about the tremendous new community hospital being built in Beverley.

Mr. Stuart: Uncharacteristically, the Secretary of State has not started with the humility that is needed, given the Government’s record. The Conservatives recognise the increase in expenditure, but, like the public and those who work in the NHS, we have not seen value for money from that expenditure. Will the Secretary of State, on his first outing, accept that that is fundamentally true—as the Prime Minister appeared to in his leadership campaign—and tell the House that he feels we must do better in getting value for money for the vastly increased resources that—to give the Government credit—have been introduced to the NHS?

Alan Johnson: It was not worth giving way. I thought that the hon. Gentleman was going to tell us about the exciting developments in his constituency, but instead we heard the same mantra that the investment that has been put into the health service has not been matched by results. It is my genuine belief that, without a change of Government in 1997, the NHS would have weakened and withered with each subsequent year of neglect. That would have strengthened the position of those who oppose the whole concept of a national health service that is free to all and based on clinical need rather than the ability to pay. The mantra of such people is that no matter how much investment is put into the NHS, it will never work because of the principal basis on which it was founded.

Norman Lamb (North Norfolk) (LD): The Secretary of State has rightly drawn attention to the fact that there have been significant improvements in many
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specialties in the past 10 years, but does he accept that there is a considerable distance still to go, particularly when the survival rates for conditions such as cancer and for strokes are compared with those in many other European countries?

Alan Johnson: May I say how pleased I am that the hon. Gentleman is the Liberal Democrat spokesman? We have history, the hon. Member for Norfolk South— [ Interruption. ] We have history, the hon. Member for North Norfolk (Norman Lamb) and I—although it does not extend to my remembering his constituency accurately. He is absolutely right: of course we will never be in a state of absolute perfection in the NHS. What I am setting out—and what I am using to counter the points made by the Opposition—is the fact that we are making huge strides forwards. I will come later to some of the issues that we still need to address, but it is right to put the debate in the context of where we were in 1997 and where we are now.

Mr. Charles Walker (Broxbourne) (Con): I welcome the Secretary of State to his new position. I knew him for a number of years before I came to this place and he is a man of great integrity and decency. As Secretary of State, he is in a profoundly important position when it comes to having an impact on the future of the NHS. In my constituency, we face the closure of hospital services in north London and services in the north of my constituency, in Welwyn. May I prevail upon him to grant me a 10 or 15-minute meeting so that I can discuss my concerns? We are between a rock and a hard place.

Alan Johnson: I would very much welcome a meeting with the hon. Gentleman to talk about the problems in his constituency.

Mr. Jim Cunningham (Coventry, South) (Lab): I hope that in his speech my right hon. Friend will draw attention to the fact that before 1997 we did not have enough doctors and nurses. In Coventry, we now have a brand new hospital.

Alan Johnson: My hon. Friend is absolutely right, and that is the story of the past 10 years. We have used investment to turn things around. The reality now is that no mainstream political party, whatever its natural instincts, would dare to fight an election openly saying that it would use public money to enable people to leave the NHS, as the hon. Member for South Cambridgeshire did when he visited the constituency of the hon. Member for Beverley and Holderness. That, of course, was the position of the Conservative party at the last general election.

Mr. Lansley: The Secretary of State will find that in our document, which he clearly has not read, we commit ourselves to accepting the 10 core principles signed up to by NHS organisations and the NHS plan 2000. Last December, his Department put forward a set of core principles from which one was omitted—the principle that public funds for health care should be used solely for NHS patients. We now subscribe to that principle, but apparently he does not.


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Alan Johnson: I am pleased that the hon. Gentleman now supports the core values and principles in the NHS document. We have always believed that public money should go to NHS patients, and that we should not put that money into the private sector, as was the Conservatives’ previous policy. [Interruption.] If the hon. Gentleman is talking about the £2 billion, that is not the case; the £2 billion that the Chief Secretary to the Treasury mentioned recently is still in the national health service, and still used for patient care. Having created the NHS and having rescued it from Tory ruin, the Government must now continue our transformation of the health service so that it can thrive in the face of the considerable challenges that affect our country in the 21st century.

Dr. Howard Stoate (Dartford) (Lab): I congratulate my right hon. Friend on his appointment, and I wish him luck for the future; I am sure that he will do a marvellous job for the NHS. Surely the real issue is the need to improve access to primary care, and therefore to improve capacity in primary care. Has he had a chance to read the report on the future of pharmacy that was produced by the all-party group on pharmacy? What plans does he have to ensure that pharmacists and general practitioners work together more closely to increase capacity in both primary care and community services, so that we can improve patient outcomes across the board and reduce some of the pressure on hospital services?

Alan Johnson: My hon. Friend is absolutely right: we can go much further as regards the 10,000 pharmacies in this country offering services. We can go much further on access to primary care services, too; I will come to that subject in a moment. Thanks to medical developments, we are all living longer, and the number of people over 85 is set to increase by two thirds by 2026. Technological advances mean that operations that were once considered miraculous are increasingly commonplace. I cite the case of the heart transplant given last week to 18-month-old baby Zoe Chambers in my constituency in Hull. We now live in a far more consumer-oriented culture, where customers rightly expect goods and services to be provided at times convenient to them.

That leads me directly to the issue of access, which is the topic of today’s debate. We need to ensure that our provision is flexible and responsive enough to meet the demands of hard-working families, who face competing demands on their time. In 1997, surgeries were frequently shut at the times when patients needed them most, such as lunch time, after work and at weekends. It was hard to make an appointment, and the surgeries were often in a squalid state of disrepair. Since then, more than 3,000 GP premises have been rebuilt or refurbished. Nine out of 10 patients can now see a GP within two working days, and more than three quarters of patients say that they are seen as soon as they think it necessary. In 1997, just half of patients said the same thing.

Anne Milton: Nurses, and particularly community nurses, are an important part of access to NHS services. When he was Secretary of State for Education and Skills, the right hon. Gentleman sanctioned an unstaged pay rise for teachers of 2.5 per cent. However, nurses have been granted a pay increase of only 1.9 per
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cent., owing to the Government’s decision to stage their pay award. Will he reconsider that decision in light of the fact that nurses are critical to improving access to care?

Alan Johnson: Nurses are indeed critical, and their pay has risen over the past 10 years. With reference to this year’s staged pay increase, it was a Cabinet decision— [Interruption.] We will not be looking at that again. We have made it clear— [Interruption.] We have made it clear that when one looks at how that works through the system, the pay increase for the majority of nurses is much—

Mr. Deputy Speaker: Order. I am sorry to interrupt the right hon. Gentleman. The hon. Lady asked a question. She should remain silent to allow the Secretary of State to reply.

Alan Johnson: Perhaps I might add that the teachers’ pay increase comes later in the year. The NHS pay increase was due to come in on 1 April and the fear was—the Conservative Front-Bench team seems to be economically illiterate on these matters—that there would be built into pay increases this year an inflation figure that would fall by the end of the year.

Barbara Keeley (Worsley) (Lab): On access to premises, when I return to my constituency office every week, I see a new local improvement finance trust centre which is nearing completion. That new LIFT centre in Walkden will replace one of the oldest, smallest and most unsuitable GP surgeries—a small terraced house—which is used by some of the most deprived and disadvantaged constituents in Salford. The GP who built that up from scratch years ago in an area of very few GPs put up his plate and built up his list from zero patients. The patients in that disadvantaged area will have access to that wonderful new centre. Does my right hon. Friend agree that for a disadvantaged area to have a fantastic new LIFT centre is a key part of access?

Mr. Deputy Speaker: Order. Before the Secretary of State answers, may I say to the House that interventions are getting longer and longer? There is quite a long list of hon. Members seeking to catch my eye, and I remind the House of the Modernisation Committee report, which alluded to the problem of too many interventions, which Front Benchers generously allow but which nibble away at the time for Back Benchers to contribute to the debate.

Alan Johnson: Thank you, Mr. Deputy Speaker. I shall simply agree with my hon. Friend the Member for Worsley (Barbara Keeley) that that is a huge development in her constituency, as in mine. There have been tremendous achievements. We have put in place incentives for doctors to do more to improve access—the point of my hon. Friend’s intervention—with the new GP patient survey directly rewarding those doctors who meet their patients’ needs. [Interruption.] We will publish the document this month. The problem with publication is that the response was so high—2 million patients responded—that we needed a little longer to get the document into a fit state for publication.


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Last weekend, the Prime Minister and I visited the Churchill health centre in Kingston, which is now open every weekday night until 8 pm and from 9 am till 12 midday on Saturday mornings. The centre does not provide such access because it is a national pilot or because it is in receipt of special funding; it is simply responding to the needs of its patients. The business case is clear, and the local personal medical services contract with the PCT provides for the practice to develop its service in this way.

We have invested more money in GPs through the GP contract, but this has been more money for better services. The quality and outcomes framework part of the contract pays GPs according to how effectively they care for their patients. This includes preventive work like gauging blood pressure more regularly.

The contract also incentivises better access. There are now around 90 NHS walk-in centres and 46 NHS treatment centres, including six commuter walk-in centres, offering free advice and treatment to all comers, without registration or an appointment. The centres are easy to access and they are open 365 days a year. They make a particular difference in improving services for the most vulnerable. We are closing the gap between GP referral and treatment times, so that waiting times are at an all-time low and more people are benefiting from earlier relief of symptoms, less anxiety and more convenient care.

We have also made it easier for patients to choose where they have their treatment. Patients needing a referral for elective care can now select from four different hospitals. Greater choice leads to better local services, and by making sure that funding follows the patient we have stimulated the development of more responsive, patient-centred services. One million people are seen by the NHS every 36 hours, and 1 million additional operations are now carried out each year. The maximum out-patient waiting time is now 11 weeks for over 99 per cent. of patients.

In-patient waiting lists are down by 476,000 since 1997, to the lowest figure since comparable data were first collected. The average wait for in-patient treatment is now six weeks. Virtually nobody is waiting more than six months for an operation. Cataract operation waiting times have fallen from two years to just three months, and waiting times for heart operations are also down to less than three months.

Almost all cancer patients are now treated within a month of diagnosis, while over 99 per cent. of suspected cancer patients are seen by a specialist within a fortnight of being urgently referred. In 1997, over a third of all suspected cancer patients had to wait longer than two weeks.

The service has been transformed since 1997, and this achievement has been a Herculean feat. I do, however, recognise that the financial turnaround and the reform programme have been delivered at some cost to staff engagement and public confidence. While those who use the NHS testify in ever greater numbers to its excellent treatment and improved resources, the public as a whole is not yet persuaded. The latest survey by the Healthcare Commission independently questioned 80,000 people with recent experience of in-patient treatment, and 92 per cent. found that treatment either excellent, very good or good, and only 2 per cent. found that it was poor.


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Mr. Andrew Tyrie (Chichester) (Con) rose—

Alan Johnson: If the hon. Gentleman wishes to congratulate us on that achievement, I will of course give way.

Mr. Tyrie: I am glad that the Secretary of State has moved off his partisan opening remarks. What relevance does the White Paper “The Governance of Britain”, which the Prime Minister has just announced, have for my constituents, 140,000 of whom signed a petition complaining about the threat to St. Richard’s hospital in Chichester, which has existed for nearly two years? They just do not recognise the picture that the Secretary of State is painting. Will he say specifically whether my local community, which has

will be given the power to take decisions, and whether, for example, it will be allowed to use the mechanism of citizens juries to influence the decision on whether that hospital should be closed or reconfigured? Does this document have any meaning at all for my constituents and those who want to keep St. Richard’s?

Alan Johnson: We are still in consultation on the issue that the hon. Gentleman raises, but these issues are driven locally, and they are driven predominantly on the basis of clinical decision. [Interruption.] I am sorry, but Opposition Members have spent a long time putting forward scare stories about NHS closures, job losses and bad services. It is no wonder they do not wish to hear the Government’s record over the last 10 years. [Interruption.] Opposition Members are asking for a moratorium on reconfiguration. These reconfigurations are being driven by local decisions in local NHS trusts, and they are driven by clinical need, not by any financial constraints. That is the simple fact of the situation.

Mr. David Burrowes (Enfield, Southgate) (Con): The Secretary of State will appreciate that he comes to his post at the very time that the plans to downgrade accident and emergency and maternity services at Chase Farm hospital have been published. Has he had an opportunity to look at the report, and will he join Sir George Alberti in recognising that there needs to be investment in primary care services and an expansion of the capacity of Barnet and North Middlesex University hospitals for the plans to be in any way viable? Does he recognise the cross-party opposition and fundamental local opposition to the plans?

Alan Johnson: In a moment, I will discuss some of the things that we need to do to take the argument forward. My point is that it is wrong to claim that proposals made in SHAs and PCTs across the country are driven by financial or political constraints; they are driven by the need to ensure a better service for the public. Overwhelmingly, that is the reason for those proposals.


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