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Lord Winston: My Lords, I was astonished!

Baroness Cumberlege: But I remember the noble Lord saying that the internal market has resulted in many hospitals improving outpatient facilities, improving comfort for patients, improving waiting times in clinics and in some cases improving waiting lists. There is no doubt that that has happened. Of course there was a wider context and I accept that, but I hope that any future Labour government will follow the noble Lord's views.

As was said by my noble friend Lord Astor of Hever, the NHS has improved enormously since the reforms. He is right, for there are countless people who have cause to be pleased that the NHS has been reformed, especially those waiting for treatment. Five years ago 70,000 people had to wait for two years or more for treatment. Today nobody waits two years and the average wait for those not needing emergency care and who are seen at once is four months. The noble Baroness, Lady Hayman, said that we were silent on that issue. We are doing so much better than

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we were last year but of course I accept the fact that with the winter pressures the waiting times are likely to increase as they do in most winters.

The noble Lord, Lord Haskel, drew a caricature of an NHS riven with competition at the expense of efficiency and care of patients. That is a false picture, as noble Lords who serve on the boards of health authorities and trusts will know. Indeed, some have testified here tonight. Patient care is at the top of the agenda of clinical staff and of professional managers alike. The right reverend Prelate the Bishop of Exeter rejoiced in the increasing number of fully funded hospital chaplains who now work in the NHS. That is the result of the internal market, which gives more certainty and autonomy to trusts. Those trusts have recognised the value of hospital chaplains not only in seeking to look after the spiritual needs of patients and staff but so often as the most perceptive of people. They see the whole organisation and they act effectively as the patients' advocate. I look forward very much to the forthcoming celebrations and development of the chaplaincy, which were referred to by the right reverend Prelate. The noble Baroness, Lady McFarlane, shared with us not only her early perceptions of the NHS but the positive contribution that the internal market has had on values and improved care for patients. I understand her point on equity but through RAWP and son of RAWP resources are now much more fairly spread. However, GPs are of course free agents and we cannot dictate where they work.

The noble Lord, Lord Hayter, in his very perceptive exploration of rationing, rightly pointed out that resources are not limitless. I believe that even the noble Lord, Lord Desai, with his engaging optimism, will agree that deciding priorities has always been necessary in all public healthcare systems. But rationing of core services should be unnecessary while there is scope to improve efficiency and effectiveness. I have heard the noble Lord on other occasions urging us to be more efficient. It is interesting that the Health Select Committee endorsed the department's view that most priority settings should be carried out at a local level within the national framework. The Government provide a framework in their priorities and planning guidance and it is then for local people to decide. We believe that local NHS bodies are best placed to assess health needs and to decide how those needs should be met.

The noble Baroness, Lady Turner of Camden, suggested that the Government have opted out of care for elderly people, and that was an issue raised also by the noble Lord, Lord Stallard. Nothing could be further from the truth. We have confirmed and clarified the responsibilities of the health service for meeting the needs of people with continuing healthcare needs, whether in hospital, the community or other places. We have placed considerable emphasis on the importance of good hospital discharge procedures and the need for effective communication between health and social services staff over arrangements for people needing continuing care.

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The noble Lord, Lord Stallard, raised also the issue of breast screening for women over the age of 60. I am extremely pleased to tell him that we are working with Age Concern to inform women that, if they wish to continue to be screened, screening is available to them. I take the point that practice staff are not always aware of that and we are doing all that we can, through Age Concern and others, to make sure that that knowledge is available to them. We are also running three pilot schemes which will operate a call and recall system for women over 60. We look forward to the results of that.

My noble friends Lady Flather, Lady Rawlings, Lady Berners and Lord Mottistone are quite right to highlight the high morale in Teeside, Cheltenham and the Isle of Wight, and, indeed, in other parts of the country. Where improvements have been made, it is right that we should rejoice in them, and we know that there are many. It makes me sad that some people appear miserable when praise is given and achievement is lauded. But I was very glad to hear this evening the noble Baroness, Lady Hayman, rejoicing in achievement, and she will know that Gloucester, Teeside and the Isle of Wight are not isolated examples.

I am grateful to my noble friend Lady Flather for setting in context the issues concerning Hillingdon Hospital. I know that she knows the inside story and perhaps, with respect, I may remind the noble Baroness, Lady Hayman, of H L Mencken's very wise words that for every difficult, complicated question there is an answer which is simple, easily understood and wrong. We know that in the health service, nobody should jump to conclusions without understanding fully all the issues involved. In this case, not only Hillingdon Hospital but also Mount Vernon and others too were concerned.

I was delighted that the noble Lord, Lord Butterfield, who has given so much to the NHS in so many fields as a distinguished academic and clinician, should be sharing his views with us this evening. It seems to me that the noble Lord may have achieved what the Common Cold Research Laboratory has failed to do over its many decades and I for one shall take his advice.

I understand the issues which the noble Lord addressed concerning research staff and the need to maintain pay parity between clinical academics and their NHS counterparts. That was an issue raised also by the noble Lord, Lord Winston. Clinical academics are university staff and their pay is therefore a matter for their employers and the Department for Education and Employment. I understand that negotiations are continuing. I know it has been a very long-running problem which we are extremely anxious to resolve.

The noble Lord, Lord Winston, shared with us his experiences as regards the lack of academics and research workers coming to this country. I believe that the picture is patchy. I was talking to the chairman and director of the MRC the other day on an informal basis and they were telling me that whole clinical teams are now coming over from the United States

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and other countries to work here, but not always to London. From my personal experience I know that there has been an increase in posts, particularly chairs in academic institutions. Therefore, I can understand that at present there is a paucity of people to fill those.

I return to the noble Lord, Lord Bruce of Donington--a very great man. In the Guardian today I saw a flyer--I think it is called a flyer--which promised us "a verisimilitudinous commemorative speech" from the noble Lord, Lord Bruce of Donington". That is a very grown-up adjective and I had to look it up in the dictionary. The definition was: "A semblance of the truth or reality; something that nearly seems to be true or real, such as a doubtful statement". That was a wrong description, because this afternoon we heard another very powerful speech from the noble Lord, who put forward forcefully his honest view. I shall not seek his redemption but I look forward to the noble Lord's continuing contributions to your Lordships' House. It is important that we should know the history of a lot of our social policy and there is no better place than in your Lordships' House for hearing that first-hand.

The noble Lord, Lord Prys-Davies, asked about the number of nurses. In replying to his comments, I should like to associate myself with the remarks of my noble friend Lord Bridgeman. The number of qualified nurses and midwives has increased by almost 48,000 since 1979 and a 14 per cent. increase in the number of training positions has been announced for this year on top of the increase of 8 per cent. for last year. To some extent, we rely on the pay review body, which looks at the issue of the nursing workforce year on year. Last year's report said that the situation was patchy in some areas but on the whole the review body believes that there are enough nurses.

The noble Lord, Lord Prys-Davies, criticised the NHS reforms. I shall let the record speak for itself. In the five years since the reforms, general and acute activity has grown by 33 per cent. compared with an estimated growth of 10 per cent. in the five years before the reforms. I assure the noble Lord that a number of executive directors of NHS trusts know to their cost that poor performance will not be tolerated.

The noble Baroness, Lady Masham, asked about the future of the Public Health Laboratory Service. I am grateful to her for giving me notice of that question. I can confirm that a review of that service is currently taking place but I assure her that no decisions have yet been made and her comments will be taken fully into account. I note also the suggestions which the noble Baroness made about an audit of treatment for those with spinal injuries. I shall certainly draw those to the attention of those in the NHS Executive responsible for clinical audit.

The noble Lord, Lord Howell, raised the question of GP services, as did the noble Lord, Lord Rea. I suspect that that will be the subject of many hours of very hot debate in your Lordships' House in the months to come as we shall be introducing a Bill. Because of the time, I hope that your Lordships will allow me to address those issues then.

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The noble Lord also took up the cudgels for the health service in Birmingham. I assure him that discussions between the parties, including the NHS Executive regional office, have taken place and continue to do so. No decisions have yet been taken and any proposals for significant changes in the health service would be subject to full consultation.

The noble Baronesses, Lady Jay, Lady McFarlane and Lady Robson, drew the attention to the importance of public service values in the running of the NHS. Your Lordships may recall that, building on the work of Sir Adrian Cadbury, in 1994 the Government published codes of conduct and accountability for NHS boards. They state unequivocally that public service values must be at the heart of the National Health Service and I was pleased that certainly in the health authority of the noble Baroness, Lady McFarlane, they are clearly respected and working.

As the noble Lord, Lord Ewing of Kirkford, pointed out, an important feature of public service is accountability to the public itself. The code of openness published last year has extended the principles of open government to the NHS. At the heart of the code is the aim that NHS organisations should give the public the information they seek except for those well-defined occasions when it is against the public interest.

Many of your Lordships addressed the issues of managing winter pressures, including my noble friend Lady Brigstocke and the noble Lord, Lord Stallard. Perhaps I may say briefly, because time is going on, that we have learnt the lessons of last winter. Since that time, planning for winter pressures has been a priority for the NHS. An extensive programme of work has been carried out at local and national level to ensure that the service is as well placed as possible to cope with the anticipated pressure on emergency care this winter.

In a spirit of conciliation and following the example of the noble Lord, Lord Ewing, I should like to conclude my contribution to the debate with a quotation. I use the words of Lord Jowitt, who said:

    "I feel quite certain that there is no subject on which it is more worthwhile to spend our time, our energy, and our resources than on the health of our people. There is no investment we can make which is more likely to repay a thousandfold, and there is no task which will more readily attract men of good will, in whatever quarter of the House they may sit".

Your Lordships will notice that there is no mention of women, but we will excuse Lord Jowitt because, as Lord Chancellor, he spoke those words on the Second Reading of the National Health Service Bill on 8th October 1946. I hope that your Lordships will agree with me that those words were indeed prophetic and that those aspirations have been met due to the careful stewardship of successive Conservative governments, the dedication of everyone working within the NHS and the good will and common purpose of the countless millions who support it, not only in the British Isles but throughout the world.

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8 p.m.

Baroness Jay of Paddington: My Lords, I should like, first, to thank the Minister for her reply. As always, the noble Baroness has given the House a very detailed and thorough response to what has been an extraordinarily interesting and well-informed debate. It has certainly done justice to the 50th anniversary which we are commemorating this evening. I am very grateful indeed to all noble Lords who have taken part and I am particularly grateful for the practical guidance of my noble friend Lord Butterfield. As someone recovering from flu, laryngitis or a combination of the two, I certainly feel that he has made the most practical contribution to my well-being this afternoon. I thank him for that.

As always when we discuss the National Health Service in your Lordships' House, we have enjoyed the vast experience and authority of many Members who come from all quarters of the country and many different professional backgrounds. It is a very complex subject but, once again, I believe that we have illustrated that there are some profound philosophical differences between some of us.

My noble friend Lady Hayman summed up the views of these Benches in a masterly speech. I do not feel that the Minister fully responded to many of her points, but at this time in the evening I do not intend to reopen them. I am sure that there will be many other opportunities to do so. I look forward especially to discussing further with the Minister the question of the lengthening of waiting lists. If I understood the Prime Minister speaking in another place yesterday correctly, he said that the waiting lists were continuing to shorten.

I should just like to express my special gratitude to my noble friends who have spoken with all their experience and expertise in health practice, in economics, in business and in political life in every part of the country. All of their contributions have been full of well-directed wisdom. It has been a particular privilege to hear my noble friends Lord Stallard and Lord Bruce of Donington, who have fought the good fight for the public service health service for over half a century. Long may they and it continue! I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

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