|Previous Section||Back to Table of Contents||Lords Hansard Home Page|
Lord Moynihan: My Lords, I am grateful to the Minister. There were clear calls this afternoon for the suspension of Zimbabwe from the Commonwealth. I would be grateful if the Minister could set out the Government's position on that specific point.
Baroness Amos: My Lords, I made the Government's position clear. We do not believe that the farm invasions, although they are serious, constitute the serious and continuous violation of the Harare Declaration which demands investigation by the Commonwealth Ministerial Action Group.
I conclude by saying that our commitment to Africa runs across all government departments. The noble Lord, Lord Moynihan, stressed the importance of this being a commitment that did not just involve DfID. Various government departments are involved in promoting growth and development in Africa. Reducing conflict is high on our agenda and we are currently undertaking a cross-cutting review of conflict prevention. We are active, too, on the issue of security sector reform because we know that in many poor countries repressive, untransparent and bloated security sectors are major obstacles to progress in development.
I have mentioned our work on anti-corruption efforts in Africa with other western governments and there are some good examples of that. We are launching challenge funds with the aim of supporting partnership initiatives. British Trade International, our newly-formed trade and investment promotion arm, is actively engaged in identifying commercial opportunities throughout the continent. On the investment front, it has worked with a number of African agencies to promote investment. And of course the Foreign and Commonwealth Office is constantly working to promote stability and security across the continent.
Now is a time for opportunity for Africa. Never before have global relationships been so important and global processes so influential to any one country's and continent's development. Those are the themes which will be explored in the new White Paper due for publication in the autumn. Africa matters, and it matters to our electorate. We have only to look at the response of the British public to recent events in Mozambique and to the debt campaign. And I agree with my noble friend Lord Desai: Africa matters to the Africans. We, as a key partner in trade, investment and development, must assist Africa in that development to ensure a sustainable future.
Over 96 per cent of Africa's diamonds do not come from conflict areas, and those firms employ large numbers of Africans. I hope that we can get some balance into this debate because I learned earlier today that De Beers, mentioned by the noble Baroness, Lady Williams, buys neither from Angola nor Sierra Leone. I beg leave to withdraw my Motion for Papers.
"Yes, there have been larger one-off rises, but never a rise sustained in this way. It means that by the year 2003-04, NHS spending will have risen to 7.6 per cent of GDP. That is a huge increase in any terms. In a period of predicted economic growth, it is unique. And it comes with an immediate injection this year of £2 billion extra for the UK, which includes the tobacco duty increase of £300 million.
"We have done this because we believe in the NHS. We never want to see it broken up, reduced to a rump service for those who cannot afford to pay for their healthcare. The NHS is a unifying force in this country and under me it will remain so. But here is the challenge to us in government and to all who work in the health service. Everybody knows that the NHS needed the new money announced yesterday. But everybody knows too that the NHS needs fundamental reform if it is to provide the standard of care people deserve in the 21st century.
"With the money must come the modernisation. A step change in resources must mean a step change in reform. In our schools, we now accept that though more investment is necessary, it is not sufficient. There is a real and often hard debate about standards, performance and reform. No one really believes that one without the other will work.
"Now is the time to raise the same debate in our National Health Service. So this afternoon I will set out the key challenges facing the NHS, the means by which we intend to tackle them and the methods for involving the people who work in the health service in this vital task.
"I say to our hard-working and dedicated staff in the NHS: you challenged us to come up with the money. We have done so. It was hard won and hard fought. There were many calls on it; many places it might have been spent. We rose to your challenge; now rise to ours. Work with us to make sure this money is spent well; make sure the NHS confronts the hard necessities of reform to improve the value we get for the money we spend.
"Some health authorities and trusts carry out four times more hip replacement operations than others. Why? How is it that some trusts can provide elective surgery for all their patients within six months while in others one in eight patients have to wait over 12 months? In some A&E departments non-urgent patients are treated within half an hour while in others there is a four or five-hour wait.
"There are trusts that see nearly 100 per cent of their outpatients within three months, while others only manage less than 60 per cent. The proportion of operations done as day cases varies from 75 per cent in some places to less than 30 per cent in others.
"There are around 5,000 elderly patients in hospital who do not need to be there because of complications between social services and hospitals over their care arrangements. Some hospitals employ twice as many nurses as others to staff critical care beds. Why is there a twofold difference in the cost of care between the best and the least efficient hospitals?
"Some hospitals manage without long trolley waits, while others have them on a regular basis. Patients can get a routine GP appointment within 24 hours in some surgeries but have to wait four or five days in others. The top 25 per cent of trusts use their consultants twice as productively as the bottom 25 per cent. There are huge variations in the proportion of patients at risk from heart disease who get the appropriate drugs to help to control their blood pressure and cholesterol.
"Nurses in some hospitals discharge patients from A&E and in others they do not. Some hospitals use physiotherapists to help to reduce waiting times for orthopaedic appointments, and others do not. Links between social services and GPs work well in some areas, but in others are virtually non-existent. Some medical teams are much better at preventing and managing conditions, such as diabetes and asthma, than others.
"These are big issues. The reasons for the variation are sometimes complex. Some of these problems will be because of a shortage of staff and equipment. But some will be poor management; inefficient organisation. Some will arise out of outdated demarcations between professionals within the service. Some will be systems failures. Some will be professional failures. Each one of these must be confronted, analysed and solutions found.
"So these are the five challenges that I set for the health service. First, the partnership challenge: for all parts of the health system--GPs, hospitals and their consultants, primary care groups, social services and community health services--to work together to end bed blocking, reduce unnecessary hospital admissions and provide the right level of beds and services for each level of care.
"Secondly, the performance challenge: the challenge is to ensure that using information, incentives and inspection all trusts and primary care groups come up to the standard of the best; that we provide the right support and intervention for those who struggle to provide proper standards of care; and that the systems are in place to identify and root out poor clinical practice.
"As a first step towards meeting this challenge, the Secretary of State will later today give details of £660 million of the extra money for next year that will be allocated straightaway to health authorities, trusts and primary care groups. He will set out how
"Thirdly, the challenge for the professions: to strip out unnecessary demarcations, introduce more flexible training and working practices and ensure that doctors do not use time dealing with patients who could be treated safely by other healthcare staff.
"Fourthly, the patient care challenge: for hospitals and primary care groups. It is to ensure that they all adopt best practice, design out delays and introduce convenient booking systems so that patients with the most serious conditions get treated quickly, and no one has to wait too long for an operation that he needs.
"Fifthly, the challenge on prevention: to balance spending on tackling the causes of ill health with treating illness, to develop a more systematic approach to treating people at risk from chronic diseases and to persuade more people to play their part in achieving better health by adopting a more healthy lifestyle.
"These are tough challenges. Together we need to find the answers. If excellence can happen in one part of the country, then I say why cannot it happen in all parts of the country. In the past two to three years, there has been substantial change and improvement. The internal market has gone; a record numbers of hospitals are being built; nurses are returning to the National Health Service; and there are more doctors in training. There are new services like NHS Direct; new standard procedures just published for cancer and heart treatment; casualty departments are being modernised; there is a new Commission for Health Improvement, an Ofsted for the NHS, charged with raising standards in all hospitals; and a new institute, NICE, to advise on the best treatments and drugs.
"But we know that this has not been enough; and too often the pressure of change has been made doubly painful by the pressure of scarce resources. Now we have a chance to put the money to work. I have set out the challenge, but I offer to meet it in partnership with those in the health service. In the next few months, the Secretary of State for Health and I will meet and talk with the people responsible for healthcare in every part of the country. We will consult the leaders of the professions and NHS organisations.
"For each of the five challenge areas, there will be a dedicated unit to examine the problems and come up with solutions. The unit will be jointly led by a health Minister and a key leader from within the health service. Because it is a national health service, I have invited the First Minister in Scotland and the First Secretary in Wales to join me in a UK-wide group of Ministers to develop and drive through the reform we devise.
"But I do not, and I will not, yield to those who believe that the NHS has had its day. It has not. A modernised NHS, not private medical insurance, is the future. The values of the NHS are every bit as relevant today as they were 50 years ago. But they have to be applied in a different way for a different age.
"The NHS is one of the great institutions that binds our country together. It is one of the great civilising achievements of the 20th century. It is our task, as the party which created the NHS, to renew it for the 21st century and to defeat the pessimists and the privatisers who would see it dismantled".
Lord Strathclyde: My Lords, perhaps I may begin by thanking the noble Baroness the Leader of the House for repeating that prime-ministerial Statement. It is an unusual Statement but not, I am sure, unprecedented. I should also like to say at the outset how much I welcome the intention to devote more resources to the health service. We on this side of the House support that aim. However, as is now well known, that was yesterday's announcement; indeed, the Chancellor of the Exchequer told us that yesterday afternoon.
In contrast, the Prime Minister's Statement today is, I have to say, a disappointment. It sounds as if the No. 10 policy unit has just given him a seminar on the problems that doctors and nurses of this country could have told him about for years. I am bound to ask: where has the Prime Minister been these past three years? He tells us that he is going--no doubt, trailing the cameras behind him--on a roadshow of discovery to every part of the country. I thought that he was supposed to be running the country.
We all believe that Britain needs additional healthcare capacity. But does not the fact that the Prime Minister has felt the need to intervene personally--and put his job on the line--show the utter incompetence of the Ministers who have been in charge of the NHS since the general election? Over most of the long life of the NHS is has been Conservative governments who have supported it, modernised it, built new hospitals and pioneered new treatments. Surely that ought to have been acknowledged in today's Statement. When the noble Baroness replies, perhaps she might show the Prime Minister the way in that respect.
One of the things that has bedevilled the NHS has been the tendency of politicians on the Left to play politics with it. Too often, when Conservatives were in power, those people belittled its achievements and seized with glee every one of its problems. We hear that the Prime Minister now expresses his anger with the media for reporting problems in the NHS. I did not sense that fury in 1995, 1996 or, indeed, in 1997 when the Prime Minister made his extraordinary remark that there were,
Pensioners with lifelong savings--people who, once again, were neglected in yesterday's Budget--have lost tax relief on health insurance. The numbers of people on waiting lists of over a year have risen when patients were promised they would fall. A new scandal has emerged of the doubling of waiting lists for the waiting list: 248,000 more than in May 1997, as a direct result of health Ministers distorting clinical priorities in 1997 and 1998 with their flawed waiting list initiative that has been roundly condemned by the BMA and every reputable medical body in this country. As the Daily Mail revealed this week, some 160,000 people are being forced to spend their savings to get life-saving and life-enhancing operations because the waiting lists for the waiting list are too long.
We have seen a transfer of choice away from the GPs, to whom we had given it, back to bureaucracy. Millions of pounds have been wasted on further bureaucratic tampering while problems on the wards have mounted. So much for "24 hours to save the NHS"; it is more like three locust years while the Government have fiddled and unmet demand for care has steadily grown. Now the Prime Minister comes forward with a Statement that lectures the NHS on its shortcomings. He tells us that he has discovered places where management is not as good as it should be. But who put it there? Was it not the Labour Party's mayoral candidate for London?
Is it not a classic comment on this Government that when the noble Lord, Lord Winston--I am delighted to see he is present--who knows the realities of the NHS, said that there were problems, he was privately bullied and publicly humiliated? But when, a few weeks later, the all-powerful focus groups revealed rising anger in the Labour heartlands about the failure of the Government's health promises, the Prime Minister panicked into action. I do not wish to embarrass the noble Lord, Lord Winston, but perhaps the Prime Minister should listen to the experienced people in his party a little more, and to the flatterers and spin doctors a little less.
What does today's Statement amount to? There is a promise by the Prime Minister to go on a roadshow and to set up new Civil Service units and Cabinet committees. And then what? He is to "prepare an action plan". When the Prime Minister talks of roadshows, units, Cabinet committees and action plans, have we not been here before with a roadshow on social security reform, a new Cabinet committee,
Does the noble Baroness agree--I hope that she does--that if the additional money is to be spent properly, that spending must be properly managed? It is a substantial increase in funding. Does she accept that you will not get good management if you persist with the appointment of second-hand politicians to run the NHS? Has the noble Baroness had time to read the Fritchie report? It shows a record of unparalleled cronyism and political favouritism in the NHS since 1997. The report finds that of 343 councillors appointed to run the NHS since May 1997, over 80 per cent have been from the Labour Party; just 10 per cent have been Liberal Democrats; and 6 per cent have been Conservative. The Commissioner for Public Appointments comments that the appointments
Yesterday, extra resources were announced for the health service. That was welcome. Today I am sorry to say that we are taken little further by a Statement that lectures the NHS on its shortcomings. We shall watch, supportively but sceptically, to see how wisely this extra money is spent. How much say, for instance, will the clinicians, the doctors and the nurses, who understand so well the problems of care, have in the way it is spent? How much, above all--this will be the test--will go to direct patient care?
After three years of waiting for a year of delivery that never actually comes, we are all entitled to be sceptical, not just us, as a political party, but also people outside the House. This is a government who tax more but deliver less. In this Budget they are again taxing more. Let us hope for the sake of the patients of Britain that this time, for once, they will actually deliver.
Lord Rodgers of Quarry Bank: My Lords, on behalf of these Benches I greatly welcome and thank the noble Baroness the Leader of the House for repeating the Statement made in another place by the Prime Minister, although at this hour it is inevitably to a rather thin House with fewer than 30 noble Lords present.
In so far as there is to be more money for the National Health Service, we welcome that without reserve. To that extent we certainly welcome the Chancellor of the Exchequer's Statement yesterday, and to that extent--although I wish to qualify my approval--we welcome what the Prime Minister said today.
It is a matter of regret that the needs of the health service were not recognised earlier. To that extent we have had three wasted years because it was plain for everyone to see that the National Health Service had been in decline for at least a decade. We must also note that welcome though the prospect for the next four years is, it is only part of the way towards the Prime Minister's aspiration--if that is what it still is--to achieve levels of spending in terms of GDP comparable to those within the European Union. Although I mention those two reservations at this stage, it is good news. The money is good news and it would be wrong to pretend otherwise.
I ask the noble Baroness a question concerning what might be called the public spending context. It is not clear to me--but this may be my shortcoming--how the announcement yesterday fits in with the comprehensive spending review. Will it mean in any respect robbing Peter to pay Paul? Have other spending Ministers been told that there will be no more money for them? Clearly, the announcement appears to pre-empt a large slice of the Government's spending for the next four years. It is fair to assume that there will be losers. It would be helpful to know who they may be; otherwise, in due course, we shall have to probe to find out.
We shall also look for double counting. I shall not repeat the rather disgraceful story of what the Government have sought to do. I do not think that it is the first choice of Ministers, but they have been urged to adopt that course--and not to their long-term advantage. We hope that there will be no "window dressing". I mean by that easy measures of apparent, short-term success which hide long-term failures. What we want to see are clinical priorities and not political priorities, although I have to say to the noble Lord, Lord Strathclyde, that political priorities did not begin in 1997. We can see them a long time before that.
However, I agree with the noble Lord, Lord Strathclyde, that if the Government are to be trusted on putting clinical priorities before political priorities and we are to have a highly competent service spending more money wisely and well, the Government must clear up the messy and indefensible situation affecting public appointments to NHS trusts and health authorities. My noble friend Lord Clement-Jones tabled a prescient, pertinent and revealing Starred Question last week on that subject. However, I do not think that it more than partially prepared us for the most remarkable and damning report of Dame Rennie Fritchie, published today. Again, I have to say that when the noble Lord, Lord Strathclyde, rather boldly refers to it, it is something of a pot calling the kettle black because this has been long-standing practice. But the fact that it is long-standing practice does not mean that it is not time for a change. I tentatively and nervously suggest that here is a case for an appointments commission. However, I shall not set out the principles upon which it should work.
I do not want to be ungracious to the Prime Minister although I and others are not impressed by his Statement. If the noble Baroness had made her own Statement, I believe that it would have been a great
Then again, those of us with experience of government will have allowed ourselves a hollow laugh at the proposal for a new Cabinet committee. It takes us back to the world of Harold Wilson and a long way from the world of new Labour, as we understood it. Our doubts are strengthened by references to dedicated units for this or that. I have never understood what a dedicated unit is; I simply do not believe in them. The five challenges are pure public relations or elementary management gimmicks. They get us nowhere, and we should recognise them for what they are.
The Statement is pretty empty and would have been better avoided. It is either an attempt to catch tomorrow's headlines--headlines for a second day of an important announcement--or, dare I say it, to prevent the Chancellor getting away with all the credit.
I simply ask the noble Baroness--it may be a rhetorical question--whether the money is aimed more at the administrative challenges set out by the Prime Minister. Or are we to believe that some will be left for improving treatment within the health service?
I have one further question of substance. I hope that the noble Baroness will forgive me if it was dealt with by the Secretary of State, Alan Milburn, in a further Statement in the other place. It concerns the existing policy targets. There are a number of targets in regard to cancer treatment, heart disease, mental health and other illnesses--they are reasonable targets; I do not dispute them--but are we to assume that the new resources will be devoted to these targets and that these targets still stand. Or are they to be widened?
I appreciate it is unrealistic to expect the Leader of the House to deal today with these and many other questions about the details of how the money will be spent. I hope very much--it is an obvious request--that we shall have a debate at an early date so that all sides of the House can examine more fully these very important developments.
Baroness Jay of Paddington: My Lords, I am grateful to both noble Lords for their broad welcome for the additional resources. As to the final point of the noble Lord, Lord Rodgers, about opportunities to discuss these far-reaching and important proposals, he will understand that that is a matter for the usual channels. I am sure, however, as always in matters concerning the health service, that your Lordships will contribute authoritatively and interestingly as the
I should say to the noble Lord, Lord Strathclyde, that I am absolutely delighted that he welcomes so full-heartedly the additional resources for the National Health Service. I had understood, from looking at the comments of his right honourable friend Mr. Portillo before yesterday's Statement, that the Conservative Party believed that there was a choice in this country between making public sector investments and cutting taxes. Mr Portillo said only a few days ago, I think on 12th March, that he would recommend that the Chancellor cut taxes rather than improve public spending. None the less, I am delighted that that position seems to have changed. I am sure that the Conservative Party's conversion to this major extension of public expenditure will be welcomed by all sides.
Both noble Lords referred to how the Statement seemed to be concerned more with administration than with the development of clinical care and the organisation of medicine. It is important to understand--I can say this having been a Minister in the Department of Health at the very beginning of this Government--that it was not until the Government started to look at the variations in performance which the Prime Minister, quite rightly, spoke at some length about today, that there was any system in place within the health service for benchmarking the comparative performances of individual trusts and individual health authorities. It was in order to establish this basic tool of management that a great deal of the preliminary work was done. If the questions to which my right honourable friend referred today about the variations in performance of different hospitals and different professional bodies in the health service had been asked in 1997, it would have been very difficult to answer them in the precise terms that he used today. Noble Lords should not under-estimate the importance of achieving the position where we can now address those variations and make decisions about the distribution of resources, which are obviously part of that issue.
Both noble Lords referred to the question of whether this settlement--which is important, both in the context of long-term management planning and the distribution of resources on a fair and improved but targeted basis--has distorted the already outlined plans for the second comprehensive spending review. The House is aware that my right honourable friend the Chancellor of Exchequer yesterday announced an extra £1 billion for education, and other amounts for transport and other high priorities within the Government's present policy objectives. Of course, the comprehensive spending review in its detail will be carried out with all the other spending departments during the next few months, but I do not think that anything that has been said--or anything that may be read into the implications of the Statement as it relates to the health service--should be read across as an indication that decisions have been made about other public sector expenditure.
On specifics, the noble Lord, Lord Strathclyde, referred to the discussion about waiting lists. I am sure that the noble Lord will be pleased to hear that the health department regards itself as being completely on target to fulfil the election pledge on waiting lists. The department and the chief executive of the health service have acknowledged that there has been what one might describe as a blip in that path upwards or downwards, whichever way one wants to look at it, in the past few months for reasons which were only too familiar to your Lordships when we discussed the problems of winter pressures. The question of out-patients is something to which the Government wish to give attention in this new planning period and in the light of this additional new money.
I suspect that noble Lords may have a slightly pessimistic view. Right across the health service, it is the case that 75 per cent of patients are seen within the patient's charter target of 13 weeks. No one pretends that we are all content with that target--of course it should be improved--but if one says that three-quarters of patients are seen within the existing target, at least we should not be too gloomy about existing standards.
Noble Lords were slightly dismissive of the plan set out by the Prime Minister to act on benchmarked information to take projects forward in the context of the new spending arrangements. I thought my right honourable friend was rather precise on that issue. He described what indeed was an administrative process--and therefore perhaps not particularly exciting--but he was fairly clear about the way in which he hopes to move forward on a consensual basis involving the health service, the professions, the different parts of the United Kingdom--he referred to consultations with Scotland and with Wales--in order to achieve a consistent and coherent new plan which would be available and ready by July this year. That would then of course be planned out in the context of the longer term spending agreements announced today. This gives the health service a very important breathing space and a capacity to plan on the basis of knowledge of what the future spend will be. That makes it more coherent from the clinical as well as the administrative point of view.
The noble Lord, Lord Rodgers, asked whether the present clinical targets would stand. It is my understanding that they will, particularly those which have been developed within the new national service frameworks and the clinical priorities which have been agreed on cancer and heart disease. I am sure that the additional money will enable new national service frameworks and new national targets to be set in specific clinical areas. Clearly, those targets already agreed--which were in themselves quite ambitious--will be held to. I suspect that clinicians will be more confident in their ability to deliver them within the new financial context.
Both noble Lords referred to quality of management within the health service--I suspect, both the professional quality of management and that which is deployed by those who sit on health authorities and NHS trusts. They referred also to the
I think it fair to point out again that headlines regarding the way in which appointments have been seen as political--even if that has not actually been the case--have been uncomfortable for all political parties. We are talking about a small proportion of Labour Party councillors being appointed since 1997. I understand that they constitute 20 per cent of the total number of appointments. Having been involved in the appointments process at an earlier stage and knowing that there are literally thousands of appointments--the total for which Ministers are responsible is 3,000--a figure of some 250 appointed councillors should not necessarily be exaggerated, although, given what my right honourable friend has said about an overhaul of the appointments system, I hope that some of the concerns about appointments made from all sides of the political process will be ameliorated.
As someone who was involved in this process as a health Minister early in this Government's term of office, I would say that one must not be over-sensitive on this matter. It was important for the Government--as it was when reforms were made by the previous administration--that those who sat on local hospital boards and were members of local health authorities genuinely believed in, and were concerned about, the way in which the government of the day sought to organise the healthcare system. As a Minister, I was pleased that people came forward for selection feeling that the health service was being focused on in a rather different way after the 1997 election. But we should also remember that all those appointments were made through the process set up by the previous Commissioner for Public Appointments.
I was pleased and flattered by the remark of the noble Lord, Lord Rodgers, that had I been making the Statement, as it were, ab initio it would have been more rigorous and substantial than the one that I repeated. However, the noble Lord, Lord Strathclyde, seemed to place some of the blame as he saw it on existing government Ministers for the disorganisation in the health system as it now stands. I am happy to plead guilty to being in that position two years ago, although the noble Lord, Lord Rodgers, has said that I would have been more rigorous today, but I cannot accept that on behalf of my noble friend Lord Hunt.
|Next Section||Back to Table of Contents||Lords Hansard Home Page|