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Baroness Masham of Ilton: My Lords, I welcome the Statement and should like to ask the Minister whether there is any hope that some of the extra money will go towards helping to prevent the spread of infectious diseases. The Minister knows what a problem MRSA is. Is there any hope of speeding up the tests for

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infectious diseases? Does the Minister agree that it is no good having wonderful new equipment if patients become ill in hospital?

Baroness Hayman: My Lords, I agree with what the noble Baroness says. I accept that in A&E departments when there are, for example, trolley waits in crowded circumstances, there is not only a risk of cross-infection, to which the noble Baroness referred, but also of pressure sores and a variety of other matters, including the privacy and dignity of patients, at a most stressful time, not being properly safeguarded. That is one of the reasons why we shall focus in particular upon medical assessment units, which will provide speedy diagnosis and consider the opportunities for isolation facilities, as appropriate.

Lord Winston: My Lords, the Government are to be congratulated on what is a very worthwhile initiative in two most important areas of medicine. The principle of using lottery money must surely be right and appropriate. It follows a model widely used--for example, the use of charitable money to such great effect in the United States for healthcare.

I wonder whether the Government have considered the possibility of using some of that money in the future for the kinds of services which are much more difficult to fund in the National Health Service. I am thinking in particular--and this is admittedly special pleading--of reproductive services. Will the Government give some thought to allowing some part of that money to be used for that purpose? In his Budget Statement the Chancellor made a great plea for the family. I am sure that my noble friend will agree that reproductive services are an important part of general health.

Baroness Hayman: My Lords, I always give thought to suggestions that my noble friend makes. I suspect that I should lay myself open to criticisms far worse than those I have received today about the funding of mainstream services if I gave him any further assurances. I understand exactly the connection that my noble friend makes and of course undertake to discuss it with colleagues.

Lord Rowallan: My Lords, while I welcome the extra funding for accident and emergency, which is the front line, I have two questions. There is to be £100 million of lottery funding this year plus £50 million over the next three years, making a total of £150 million. As all citizens of Great Britain together put money into the national lottery how, with devolution, will those funds be distributed to the different parts of the country? Presumably the money must be given to Scotland, but not for specific projects.

The Hampshire Magpie scanner appeal has been working hard to raise money. Can the Minister confirm that the main idea is to augment funds that have already been realised or to have completely new scanners, and so forth? Which will have higher priority?

Baroness Hayman: My Lords, priority will very much depend on regional cancer leagues informing us of

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their priorities. For some, the priority will be to replace equipment. Others will want added capacity. We need to view the matter from the patients' perspective, to ensure speedy access to effective treatment. There is no one answer but we should look at the output in terms of what the patient sees from the investment. Like the noble Earl, Lord Howe, I thought of my noble friend at Christie Hospital and how he would have reacted to the possibility of investment.

The noble Lord, Lord Rowallan, referred to how the funds would be split between the four countries. The £150 million for the UK as a whole, excluding administrative costs, will be allocated in such a way that over time, 77.5 per cent. will be committed to projects in England; 11.5 per cent. in Scotland; 6.5 per cent. in Wales; and 4.5 per cent. in Northern Ireland.

Lord Skelmersdale: My Lords, I have no quibble with using lottery money for capital equipment in the National Health Service. That is the right way to proceed. As many have said, including the Minister, it is an adjunct or fillip to what goes on. My noble friend Lord Rowallan mentioned a scanner in Hampshire.

The Government have three priorities for the health service this year, They are cancer, cardiac treatment and--it was a surprise that my noble friend did not mention this--mental health. In this additional tranche of money that the Government have courageously provided, just one of those priorities is singled out. Why could not the money be spread a little more thinly and appropriately, according to the Government's own priorities?

Baroness Hayman: My Lords, we have made it clear that, in terms of lottery funding, expenditure was on cancer services, where we felt there was a need for the catch-up exercise--particularly in respect of equipment. The noble Lord rightly draws attention to other priorities. One is mental health, for which the national service framework is being drawn up and substantial additional funds have been allocated. We have ring-fenced additional funds for mental health. We are currently working too on the national service framework for coronary heart disease, where I am examining the resourcing implications. It is important to acknowledge that demand but there are demands also for the drugs budget and public health areas such as smoking cessation support, which will have a great effect in respect of coronary heart disease. I do not think that we are neglecting those two areas.

Baroness Emerton: My Lords, I also welcome the funds that have been allocated, and particularly the emphasis that my noble friend the Minister placed on the importance of accident and emergency departments and admission beds. Having just personally experienced the upgrade of A&E departments and the introduction of admission beds, I know that the Statement will be much welcomed throughout the NHS.

However, while an A&E department is being upgraded, use of it is halved; that creates pressures, particularly in the winter, and makes life difficult for nursing staff and patients. It increases trolley waits and other pressures in the department. While trying to deal with the government

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initiative to reduce waiting lists, one must acknowledge the pressures created when money has to be spent over time.

Baroness Hayman: My Lords, my noble friend gives wise advice. Anyone who has lived through the major upgrading of an A&E department knows exactly how disruptive that can be for staff and patients alike. She is right to say that upgrades should be timed carefully and not at the peak of demand. A variety of smaller schemes will not necessarily involve the same disruption and could be successfully progressed. The carrot of knowing that new facilities will be made available takes people through the sticks of adversity and living with the builders.

Lord Warner: My Lords, I also welcome my noble friend's Statement. Does she agree that one of the greatest concerns of recent years has been the number of assaults on NHS staff and that a significant proportion have occurred in A&E departments? Will her Statement lead to a significant improvement in the security arrangements for staff working in A&E departments and will there be close co-operation between NHS trusts, community safety officers and the police?

Baroness Hayman: My Lords, my noble friend is right to draw attention to that aspect. Additional security facilities were among the priorities in the additional investment of £30 million from the modernisation fund. He is right to say that A&E departments are a particular flashpoint, which can create danger and distress for staff and patients alike. We must ensure that improvements are made in closed-circuit surveillance, and that is provided for in some of the schemes. My noble friend is sensible to suggest that local police services are involved in examining how that can best be done.

As well as the specific expenditure focused on security, other measures will include improving services overall, cutting waiting times and improving the quality of the surroundings in which people wait, and reducing access times to radiology and pathology. Improvements will reduce stress levels and, hopefully, levels of violence against staff and patients.

Baroness Gardner of Parkes: My Lords, I have a similar line of questioning to that of my noble friend, Lady Cumberlege, but we arrived at our questions quite separately. I have a particular interest in GP work in main streets and shopping malls. In Australia this occurs almost everywhere. The system of funding the health service in Australia is very different. Patients choose where to go and then reclaim what they have paid according to means after the event. That is a real test of patients' choice. They have greatly welcomed the provision of surgeries in shopping malls, to the extent that they have been expanded enormously.

As I understand the Minister, the service is intended to be free to the patient. I ask that question again. It is said that it will be at places and at times convenient to the patient. We would all like that. But the statement that this is not intended to replace general practice but to augment it may give rise to some risk. If patients take to this free

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service in a big way there will be a great demand for it. If a patient goes to a doctor in a shopping mall and the doctor gives a prescription--my noble friends have already asked how he will be paid, and, presumably, it will be done on a sessional basis--from whose budget will that come? How will it be fair either to general practices or to any other source? How will it be allocated?

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