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Lord Hunt of Kings Heath: My Lords, the noble Lord has raised an important question about the capacity of the NHS to handle the extra resources that it has been given. My experience is that the NHS has been good at handling less than adequate resources and still keeping the show on the road. The tremendous challenge now is for it to go through an enormous culture change to use the extra resources to the best effect. I agree that it would be a tragedy if those resources were not used to achieve a significant change in NHS provision and a significant improvement in what the public receive.

There are four ways of ensuring that the money is put to good effect. As I said in the Statement, we are moving to a management philosophy that we call earned autonomy. For many years, there have been complaints about too much interference from the Department of Health in the affairs of local health authorities. We are trying to develop a way of working that rewards people who are meeting their priorities and doing good work. They will receive additional resources and will be given more freedom to use those resources well, because they have proved that they can be trusted.

However, for health authorities with real problems we shall have a more interventionist approach. We have a modernisation agency and the Commission for Health Improvement. We can intervene if we are not happy with the performance of local management. We can bring in people who have done well elsewhere to help the authority to make changes, while keeping a close eye on developments.

Overall the health service has good management, although it is variable. We need to invest in it more. Our proposal for a leadership centre is designed to identify the health service leaders of the future and to give them the support, training and monitoring that they require.

Baroness Hanham: My Lords, I declare an interest as chairman of a health service trust. Two issues particularly strike me in what the Minister has said. The first is the welcome announcement of extra money for nurses to help with accommodation. Will the

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Minister be kind enough to say a little more about the possibility of the health service providing accommodation? There is a real difficulty, particularly in London, that even £1,000 will not make a row of beans' difference to the ability to attract and recruit nurses because of the cost of accommodation. The health service probably wishes that it had not systematically got rid of all the old nurses' homes over the years, because it will need to return to providing some accommodation.

The second issue, to which my noble friend Lord Howe referred, was the absence of any mention of doctors in the Statement. Will the Minister comment on the fact that the reduction in junior doctors' hours has put a considerable burden on consultants? Although there was an aspiration to consultant-led services, there are nothing like enough consultants to run them. Is there an expectation of an uplift in the number of consultants in all specialties, not just those that the Minister referred to as the primary centres of focus? If not, very soon we shall see consultants working the 102 hours that the junior doctors worked.

Lord Hunt of Kings Heath: My Lords, I thank the noble Baroness for her questions and acknowledge her work as chair of an NHS trust. Throughout the country such chairs face considerable leadership challenges in ensuring that we improve and develop services.

The absence of any mention of doctors from the Statement is not meant to undervalue their importance to our National Health Service. One of the most pleasing aspects of writing the NHS Plan and developing its implementation is that many doctors who work in the front line have helped us to draw up our proposals. That creates confidence, because there is nothing in the plan that is not being done somewhere in the National Health Service by good people. The great challenge is to bring everyone up to the level of the best. The resources that we are making available will make that possible.

The noble Baroness will know that we have set out our proposals for an increase of 7,000 in the number of hospital doctors. That will go a long way to meeting the challenges and issues that she has mentioned. There has also been an increase in the number of doctor training places, with an expansion in existing medical schools and the opening of some new ones. We have a more sophisticated approach to workforce planning for doctors than ever before. That will enable us to make more considered judgments about how many more doctors we need both to relieve current pressures and to allow us to expand services as we want.

The Lord Bishop of Birmingham: My Lords, coming from Birmingham--a city that the Minister knows well--I welcome the attention to inequality. Birmingham has suffered terribly from under-resourcing in its health provision, partly through its own fault, because people could never agree on what they wanted. It is not least due to the noble Lord's

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work before he became a Minister that something is being done about that at last and the health service in Birmingham is finally responding.

I have three questions--two specific to Birmingham and one more general question. First, we have heard a lot about the development of ambulatory services. When are we going to hear something about that in Birmingham? Perhaps there has already been an announcement that I have missed. Secondly, how soon will we know whether Birmingham will get a new hospital? I declare an interest as a non-executive director of the University Hospital Birmingham NHS Trust. Thirdly, the Minister has rightly emphasised waiting times, not just waiting lists. The issue is not just a matter of resources, but of how they are used. Rather than just asking people to do their job ever more quickly, we need to be more imaginative and to have some joined-up thinking on how people are referred. We need fewer paperchases and more imaginative use of information technology. We should ask what effort is being put into encouraging the reduction of waiting times by more sensible use of resources.

Lord Hunt of Kings Heath: My Lords, I am glad to respond to the right reverend Prelate and to his particularly interesting questions about Birmingham. I am pleased to be able to inform him that part of the announcement made yesterday about 18 new hospitals related to the new ambulatory care centre at Birmingham City Hospital. As he will know, that is the outcome of a recommendation of the independent review body of which he served as an excellent member. I am afraid that I do not have in my back pocket a new hospital for the university trust. However, I can assure the right reverend Prelate that we shall make announcements in relation to the conclusions of the consultation process as soon as we can.

I agree with the point that he made in relation to tackling waiting times and waiting lists. In parts of the health system the process from GP to secondary referral to tertiary referral has been examined and a dramatic reduction in waiting times and lists has been achieved. We also know, for example, of orthopaedic departments in certain hospitals where the consultants are prepared to let go and allow physiotherapists and OTs to take on more work. Again, in such cases drastic reductions in waiting times and lists have been achieved.

We face the tremendous challenge of encouraging the whole NHS to take on those new ideas and to engage in good practices. Overall, I believe that the combination of extra resources, the concept of earned autonomy whereby people who are doing well in bringing about change are rewarded, and our ability to intervene in places that are not doing so well will be the best approach in achieving the type of change that the right reverend Prelate desires.

Lord Forsyth of Drumlean: My Lords, I hate to break up the party, but I do not believe for a moment that the resources announced today by the Minister will be sufficient to meet demand in the health service, taking into account the development of technology and an ageing population.

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Several times we heard mention of the phrase, "first in the history of the health service" but perhaps I may ask the Minister about one specific matter which was not mentioned in his Statement.. Can he confirm that this Government are the first in the history of the health service to set a cash limit on the drugs budget? Under that limit, doctors are unable to prescribe drugs according to their clinical judgment because they are restrained by the cash limit imposed by this Government. Will the Minister consider removing those cash limits, or are we to see the inappropriately named organisation, NICE, continue to introduce rationing and deny people the care which they require--high quality care through drugs and other areas which we see being provided in other countries in Europe?

Can the Minister address his mind to the inequality of outcomes in France and Germany because drugs are available at a cost through the health care system? Can he also address his mind to the inequality created by the Government in this country through the introduction of cash limiting, which prevents drugs being available and which threatens the central principle of the NHS that people should receive the care that they require according to their need and not according to their ability to pay?

Lord Hunt of Kings Heath: My Lords, I believe that the noble Lord is entirely wrong in his supposition. The intention behind the establishment of NICE was to end the legacy of postcode rationing which this Government inherited. Drugs were available in one part of the country but not in another, and patients were eligible to receive treatment in one part of the country but not in another.

The establishment of NICE was intended to provide the most authoritative guidance possible on the effectiveness and cost-effectiveness of drug treatment and other medical treatments in order to ensure a much greater uniformity of use within the National Health Service. We have seen the results of that in the initial recommendations made by NICE in relation to certain cancer drugs and in other recommendations. As those recommendations are adopted by the health service, people are in a better position to receive drugs and treatments which NICE has advised are effective and cost-effective.

Instead of the ability to obtain drugs resting on the variability of parochial decisions, surely it is better that that ability now rests on the best evidence available. The ultimate aim of NICE will not be to restrict treatments which are effective and cost-effective; it will be to ensure that they are provided uniformly throughout the country.

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