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Baroness Hayman: My Lords, I am glad to have the opportunity to do exactly as my noble friend requests.

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Social services staff have played an enormously important part. When talking to NHS staff, a recurring refrain is how much worse the situation would have been if last winter we had not built up the relationships that are paying dividends this winter. We tend to focus on A&E departments, but the difficulty can go right through the system. If the system is not working smoothly and if there is not adequate social care provision to enable those who are well enough to return home to do so, the difficulty will again be felt at the acute end, in the A&E departments. Indeed, A&E consultants focus on the importance of social care to them in managing their workload. It is interesting to note how much of the £159 million that has already been allocated has been given specifically to social services schemes. I know that in the eastern region some of that extra money is being spent on pressure-reducing mattresses so that patients can be safe at home with good quality care.

That reminds me that I did not respond earlier to the noble Earl's point about the £50 million which is being made available. I should not like to be definite about this because bids are still coming in and being assessed, but my impression is that we shall probably have just about the right number of effective and robust bids to tally with the £50 million which has been kept back from the £209 million.

Lord Naseby: My Lords, is it not depressing that, when the situation is nowhere near an epidemic, parts of the NHS cannot cope? Will the Minister confirm that it was her Government who voluntarily accepted the spending plans that they inherited and who decided to phase nurses' pay? Is it not a fact that in the past 12 months the number of nurses leaving the profession has been at an all-time record? Against that background, surely the Minister can give this House a commitment that in the year to come the pay awards of all medical staff will be implemented in full, at whatever level they may be?

Baroness Hayman: My Lords, the noble Lord is sufficiently experienced a parliamentarian to know that I cannot give that commitment to this House in advance of the report of the pay review body. The noble Lord is absolutely right that a number of issues result in nurses leaving the profession as well as in people not entering it, and that we must address those issues. The Statement referred to some of the long-term and medium-term measures that we are taking to do precisely that.

On the incidence of illness, the noble Lord said that this is nowhere near an epidemic. I shall check the figures, but it is interesting that the rate of 200 GP consultations per 100,000 was, until 18 months ago, classified as a "moderate epidemic". The terminology was then changed. The noble Lord is absolutely right that this is not a major epidemic, but the threshold is the same. The incidence of flu this winter is above the winter norm.

In addition, we are seeing the four-yearly cycle of mycoplasma illness, which is particularly difficult to deal with. There is some evidence that some of the flu-like illnesses that are being reported are of particular

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severity for those with respiratory problems. That is creating more demand for hospital rather than primary care services and for intensive care beds. Obviously, however, the picture is still emerging.

Baroness Ludford: My Lords, while I welcome the Minister's recognition that the health service needs more beds, does she accept that many Londoners regard it as a pity that the Government did not reach that conclusion nearly two years ago when they came into power? The Government might then have accepted rather less of the previous government's disastrous decimation of London hospitals. What beds in London hospitals will it now be possible to save from closure? What are the implications for hospitals in London? For instance, Barts has a splendid intensive care unit but, under PFI scheme merger plans, many of the local beds will be lost. What will be the immediate consequences of the Government's recognition that there is a lack of beds?

Baroness Hayman: My Lords, I do not think that there are immediate consequences other than the schemes that are being put in place under the additional winter pressure funding expenditure this year. I have explained before to your Lordships' House, and made it clear in the Statement, that we are carrying out a national review in order that we can look properly at the need for, the disposition of and the types of beds that the health service overall requires. As the noble Baroness is well aware, the Turnberg Review was particularly helpful in this. Given the controversy that there has been over many years about London health services and the appropriate pattern, it is not possible to come into government and take a snap decision and say "This is the right way forward". It was appropriate to have the Turnberg Review and it is absolutely appropriate to take decisions in the light of the ongoing national beds review.

Lord Davies of Coity: My Lords, it is not my intention to repeat the circumstances that have arisen from the flu epidemic or to comment on the failure of the previous government to train nurses in sufficient numbers, a failure which has given rise to many of the problems that we now have. It is my intention to address the severe criticism that the Conservative Front Bench has made of the commitment of the Labour Party in its manifesto to reduce the waiting lists of patients requiring medical treatment.

That criticism is not only unjustified but lacks compassion. It demonstrates the clear difference between the Conservative Party and the Labour Government. The way that the term "waiting lists reduction" or "increase" is used by the Opposition reflects some kind of paper exercise. The Labour Government recognise that it means people. It means people who are waiting for medical treatment--large numbers of them waiting for surgery--and waiting for months, sometimes years. It means people who do not have private medicine available as an alternative. When the Labour Government talk about reducing waiting lists, they are concerned about the people.

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I still remember the great cry at one time--

Lord Skelmersdale: My Lords, if the noble Lord will allow me, The Companion makes it quite clear that Back Bench responses to a statement should not occasion a debate. I am sure that the Minister would welcome a question from the noble Lord. To pursue this in the form of a debate is not in the traditions of the House.

Lord Davies of Coity: My Lords, I will finish this last sentence and then ask the Minister if she recalls and agrees with me that there was a cry by the previous government to the effect that "The health service is safe in our hands". We know that was not true. The British people knew that it was not true, and decided on it in 1997.

Baroness Hayman: My Lords, my noble friend very eloquently confirms that it is not a matter of either/or in the health service. We have to meet the needs of all those who require treatment and care, whether they are waiting for admission for surgery or are acutely medically ill. It is about balancing those needs and providing for all of them throughout the system. We must recognise that each of the statistics represents an individual, whether it is an individual waiting for a long time on a trolley or an individual waiting for admission to hospital and having that admission cancelled. They are individuals and we have to be very well aware of the impact on them and their families.

Lord Alton of Liverpool: My Lords, I would like to be clear about what the Minister said about the seriousness of the situation on Merseyside. She mentioned that the number of calls on ambulance drivers has risen from the usual 500 per day to more than 1,000 per day. In the light of the seriousness of the crisis there, will the Minister say what emergency steps are being taken in the area to address that problem?

In addition, the Minister will recall that a large number of beds were closed in the previous four years, including the Broad Green Accident and Emergency Unit. As part of the review which is now under way, will the Minister ensure that those areas which have suffered a loss of beds or the closure of units are particularly looked at with a view to reinstating them?

As to the subject of nurses, may I commend to the Minister the article which appeared yesterday in the Sunday Times, penned by Melanie Phillips. I hope that she will find the time to read it, as it deals with a number of the questions which have been raised here today.

Baroness Hayman: My Lords, luckily I found the time to read it over the weekend. I am not sure that I shall have a lot of time this week.

Yes, Merseyside has had a particularly difficult time. It is important that we look at the lessons to be learned from the pressures of this winter, both in planning for next winter and in the context of provision in response to the findings of the overall bed review.

As to the specific help which is being given to Merseyside at the moment, for example, schemes are being carried out to reduce intensive care transfers in

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Liverpool and East Lancashire, with an extra ICU in Manchester and a HDU in Stockport, and so on across the area. Perhaps I could write to the noble Lord in a little more detail about that.

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