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The NHS was the creation of all three parties. Its fundamental principles have never been under greater threat.
My right hon. Friend the Leader of the Opposition has constantly confirmed our commitment that the NHS is our No. 1 priority, and that under an incoming Conservative Government it will continue to be a public service free at the point of need, with access based on need, not on ability to pay. I hope that even at this late hour the Government will support that part of our motioninterestingly, their amendment would delete that crucial overriding principle and value without repeating it or replacing it with words of their own. What do they mean by that?
Last December, when he was a Health Minister, the new Chief Secretary to the Treasury undertook the Governments consultation on the core principles of the NHS, which we have committed to enshrining in legislation. In that consultation, the Government omitted the principle that
public funds for healthcare will be devoted solely to NHS patients.
Amidst the various disasters that befell the NHS on the watch of the right hon. Member for Leicester, West (Ms Hewitt), the negotiation of the new GP contract will be remembered as one of her biggest political tombstones. The cost was over £250 million more than the Government had originally intended, for a service that had been slated by the National Audit Office [ Interruption. ] I am happy to take all bids for admission of failure.
What does the Minister intend to do about those costs? As the motion makes clear, our recommendation is that practice-based commissioning be developed to provide greater incentives for the integration of GP services with out-of-hours care. I hope that the Minister will not be tempted to repeat the point that 96 per cent.
of practices have taken up practice-based commissioning. As I have discovered through parliamentary questions, his Department only counts GP practices that take up component 1 of the PBC incentive payment, which is, in effect, free money: 95p per registered patient if the practice submits a plan on how it intends to deliver direct enhanced services. The practice receives that money whether or not it delivers on the plan. Component 2 of the payment is made available when it actually delivers, so I was not surprised to discover that information about the take-up of PBC is collected only at primary care trust level. Will the Minister tell us what percentage of GP practices have taken up component 2?
We also recommend the use of PBC to integrate urgent care. Will the Minister give us the timetable for publication of the urgent care strategy? The White Paper, Our health, our care, our say promised:
During 2006 we will develop an urgent care strategy for the NHS.
However, we are halfway through 2007 and all we have from Ministers is a commitment to publish in due course. We also await the review of walk-in centres and the patient access survey results. As regards the former, a year ago last month, according to the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis)who has not returned to the Chamber:
The matters are still under consideration.[ Official Report, 13 June 2006; Vol. 447, c. 1161W.]
My hon. Friend the Member for Beverley and Holderness (Mr. Stuart), who has been a tireless campaigner on behalf of community hospitals, made a justifiably impassioned late contribution on the subject. Since 1999, more than 3,000 community hospital beds have been lost, 27 hospitals have experienced closures and 139 are under threat. Only £50 million of the £750 million community fund budget announced last summer has actually been allocated to community hospitals, with a further £50 million to polyclinics. Moreover, the Government have dropped their 2005 election manifesto pledge to build or refurbish 50 community hospitals. When will the Minister start defending community hospitals, which are the key to delivering care closer to home?
We have heard from Members on both sides of the House who face the threat of closure of their local accident and emergency departments. In April, when questioned by my hon. Friend the Member for South Cambridgeshire, the former Secretary of State refused to say whether she endorsed or rejected the Department of Health guidance on the subject. Will the new Minister tell us what he thinks? I caution him that if he accepts the Departments guidance
that to be viable, a full A&E Department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people
a claim for which we have seen no evidence, but which is being prayed in aid by strategic health authorities hoping to close A and E departmentshe will be condemning 92 of Englands 204 A and E departments to closure, as was highlighted in an intervention about Haywards Heath by my hon. Friend the Member for Mid-Sussex (Mr. Soames).
Mothers-to-be in England might take heart from the elevation under the new regime of Government campaigners for maternity services. The new Secretary of State for Communities and Local Government is protesting against the closure of maternity services at Hope hospital in Salford. The new Home Secretary is protesting against closures at the Alexandra hospital in Redditch. Mothers-to-be will be pleased to hear that the Under-Secretary, who is still not in the Chamber, and who protested against the closure of maternity services at Fairfield hospital in Bury, is the only Health Minister from the previous line-up to keep his job.
Unfortunately, what the hon. Gentleman does in his constituency seems to bear no relation to the policies he signs off at Westminster. We have repeatedly asked for clinical evidence for reconfigurations of maternity services. The report failed to provide it and the hon. Gentleman confirmed that the necessary research will not be concluded until 31 August 2009, yet the mad march of threatened closures continuessuch as the closure at Horton, as has been repeatedly and ably pointed out by my hon. Friend the Member for Banbury (Tony Baldry). Sixty per cent. of those services are operated by providers that finished the 2005-06 financial year in deficit, and 65 per cent. of them are situated in parliamentary constituencies held by Opposition MPs.
It is depressing that yet again the choose and book statistics have been run out. As long as a person has made just one phone call, even if it is completely useless, it is counted in the 85 per cent. successful use figure.
In the spirit of consensus building so beloved of the new Prime Minister, we have today taken a constructive approach and offered a positive way forward, but neither in their motion or in the debate have the Government attempted to answer any of our points. Perhaps the Minister, who is fresh from ducking the issues on badgers and controlling the spread of bovine TB, can set a new example of Government transparency when he speaks. Spending is not the same as delivering.
Surely now that the clunking fist of the ex-Chancellor has grasped power, the Government should recognise that there is a large elephant in the room, which is, as they say in the motion, their suggestion that the staff and the medical profession have worked hard to deliver the Governments targets. Nothey have worked hard to deliver better patient care and they have done so by working not necessarily with and for the Government, but often despite the Government who have set the top-down targets. That is why we need a new freedom of access and free access that is equitable across the country. I ask my hon. Friends on the Opposition Benches, and perhaps some good-thinking friends on the Government side, to support the motion.
The Minister of State, Department of Health and Minister for the South West (Mr. Ben Bradshaw): This has been a mainly good debate and many important points have been raised. I acknowledge the warm welcome that Members on both sides have given to the new team on the Government Front Bench.
The health service we inherited in 1997 was starved of essential funding. Every winter heralded a new crisis, cancer death rates were going up, waiting lists topped 1 million, there was a shortage of beds, patients were left on trolleys in A and E for hours, and half of all hospital buildings had been built before 1948. Ten years on, the position is transformed thanks to greater investment, difficult but necessary system reform and, above all, the tremendous work of those who work in the NHS.
As recent successive independent surveys have shown, patient appreciation of the health service is at record levels. The Healthcare Commission survey, in line with previous years, showed that more than nine in 10 people rate their care as excellent, very good or good. The recent Commonwealth Fund survey of international rankings looked at the health services of the UK, Australia, Canada, Germany, New Zealand and the United States against health system indicators of quality, equity, healthy lives, access and efficiency and it placed the UK first, an increase of two places since 2006.
Mr. Bradshaw: Certainly not. I very much regret that not all Back Benchers were able to contribute to the debate because the Opposition went on for too long. I will not give way in the 10 minutes that I have left to respond to the very important points that Back Benchers have made.
The Government accept that the transition that we have put through since 1997 has been delivered at some cost to staff engagement and some measure of public confidence. Those who use the NHS testify in ever greater numbers to its excellent treatment and improved resources, but the public as a whole are not yet persuaded. Deficits in some health trusts place unwanted additional strain on hard-working NHS staff.
I now come to some of the points that have been made in the debate. The hon. Member for North Norfolk (Norman Lamb) was absolutely right when he said that health inequalities remain a major challenge. Access to GPs, for example, differs widely even within regions of the country. In the north-east, there are 133 per 100,000 of population in Northumberland compared with 25 per 100,000 in neighbouring Redcar and Cleveland. He is right to say that we have more to do on that, and we are doing so through the fairness in primary care procurement. We have been working with the 30 primary care trusts with the fewest GPs for their populations, and contracts with new providers should improve access to services for thousands of people living in those areas. Advertisements for the initial fourHartlepool, Nottinghamshire County Teaching, County Durham, and Yarmouth and Waveneywere placed in April. Advertisements for a further six PCTs were published for Ashton, Leigh and Wigan, Bolton, East Lancashire, Luton Teaching, Manchester and Trafford.
The hon. Gentleman is also right to point to the problems that we still face in audiology. We acknowledge that waits for hearing aids are still too
long and we published a framework for tackling the problem in May. The Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), will publish the Governments response to the Health Committees recent report shortly.
I can reassure the hon. Gentleman that there will be no change in the Governments approach to independent sector treatment centres, and he is also right to say that challenges remain in orthodontics. As he will know, the old system led to huge variations in the provision of orthodontic services, because orthodontists could decide for themselves where to set up practice and how much work to do for the NHS. Last years reforms will address that issue, but I have to point out that the NHS spends more on orthodontic services per head of population than any other state-funded system in the world.
The hon. Member for Romsey (Sandra Gidley) said that she thought that the provision of dentistry was getting worse. That is not the case. NHS dentistry is expanding nationally. PCTs are now commissioning more dental services than the year before the reforms, and in March 2007 there were more than 21,000 dentists on NHS lists, an increase of 4,000 since 1997.
Most of the points made by Conservative Members seemed to focus on the configuration of hospital services, and community hospitals and community services in particular. The configuration of hospital services must be a matter for the local national health service. We do not believe that it is central Governments role to micro-manage every local health economy. As my hon. Friends the Members for Wakefield (Mary Creagh) and for South Swindon (Anne Snelgrove) and my new hon. Friend the Member for Grantham and Stamford (Mr. Davies), in an excellent contribution, made absolutely clear, reconfiguration in their constituencies has led to considerable benefits in terms of health service provision.
As the hon. Member for North Norfolk pointed out, the implications of the Conservative partys policy are more closures of community hospitals being decided not at local level but by a national quango. That is not the route that we intend to go down. Far from closing hospitals, this Government have delivered the biggest hospital-building programme ever, with 109 new hospitals open or under construction since 1997. The reconfigurations are taking place because doctors are telling us that specialist care needs to be concentrated in centres of excellence so that clinicians with the right expertise, experience and equipment can treat the sickest patients safely and conveniently.
Conservative Members also asked what the Governments approach to targets would be and how many targets we have got rid of. My information is that targets have reduced in number over the past three strategic reviews from 108 to 20. The 18-week wait is the only remaining target when it comes to access.
We were presented with a paper by the official Opposition and, as my right hon. Friend the Secretary of State said, we will take a look at it. On the face of it, either the things that they are proposing are already under way, or we do not believe that they are necessary to achieve the improvements that we all want. As the hon. Member for Wellingborough (Mr. Bone) acknowledged in the Cornerstone paper, a large bulk of the Conservative party want private health insurance to pay for tax cuts.
As we move to the next phase of the NHS transformation, we agree that there should be much greater focus not on top-down reforms, but on stimulating change among patients and practitioners. The policy framework that we set out will be right only if the views of staff and patients are properly incorporated. A modern NHS must move from a public sector monopoly to a truly patient-led public service. The previous ministerial team, to whom I also pay tribute, took significant steps towards creating an independent, self-improving NHS, steadily removing powers from the hands of politicians and transferring it to clinicians. Increased transparency and independence have brought undoubted improvements, but have also had a short-term effect on confidence. However, we were right to introduce those changes.
Patients need staff to take the time to explain the condition and treatment options, and citizens need to know what is going on and to be properly involved in collective decisions. We introduced national targets to eradicate the unacceptably long waiting lists, and without those targets, the NHS would not have seen the transformation of services that I described earlier. But the treatment needed for the NHS then, when the whole system was in intensive care, is not the same as the treatment it needs now. We are determined to move away from targets as we transform the NHS from a top-down bureaucracy to a bottom-up, self-improving organisation with power in the hands of patients, their advocates and, crucially, GPs and others in primary care and the staff.
Waiting lists and waiting times are at record low levels. The Government are on course to hit next year their 18-week target for the waiting time from GP referral to treatment. We have seen huge falls in deaths from heart disease and cancer. There are 80,000 more nurses and 35,000 more doctors, and there is better pay for our brilliant NHS staff. There are more than 100 new hospitals. That is what the Labour Government meant when we promised to save the NHS after 18 years of Tory neglect. Of course we must learn from mistakes and listen to our critics and, in particular, to those who work on the front line, but our overriding principle must be what is in the best interests of patients. It is absurd to deny that our health service is in immeasurably better shape than it was 10 years ago. Under this Labour Government, it will continue to get better.
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