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House of Lords

Monday, 12th March 2001.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Hereford.

NHS Trusts: Resources

Lord Clement-Jones asked Her Majesty's Government:

    Whether National Health Service trusts have adequate resources in the current year to meet their targets and other obligations and still to break even.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, the additional resources made available to the National Health Service in 2000-01 mean that overall the service is forecast to achieve financial balance and is on track to deliver the national priorities guidance targets.

Lord Clement-Jones: My Lords, I thank the Minister for that Answer. He will have noted that in a letter from finance chiefs of NHS trusts to the NHS Chief Executive they stated:

    "The level of ambition set out for next year is beyond the resources available".

They go on to state:

    "We will not be able to deliver the key targets required. We are resolute in our belief that the financial gaps we are now facing cannot be closed by normal measures".

In view of the fact that last week the Chancellor failed to give additional current expenditure to NHS trusts, should not the Minister now admit that the targets and initiatives which he and his colleagues set for the NHS are over-ambitious and that some of the targets are unlikely to be achieved?

Lord Hunt of Kings Heath: My Lords, it is the time of year when finance directors of trusts negotiate with health authorities exactly what they will spend next year and the services which they will provide. It is not unusual for dire predictions to be forecast by finance directors, which often turn out to be less serious. I suggest we await the outcome of the negotiations before drawing hard conclusions. A real-terms increase of 6.2 per cent will be given to health authorities for next year. That is an extremely significant increase, which will go a long way towards enabling us to improve and increase services, as set out in the National Plan.

Baroness Masham of Ilton: My Lords, is the Minister aware that some busy hospitals are under immense pressure? Is he also aware that the chairman of the trust and half the board of the world-famous hospital, Stoke Mandeville, have just resigned?

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Lord Hunt of Kings Heath: My Lords, I am certainly aware of the enormous contribution made to the NHS by the spinal injuries centre at Stoke Mandeville Hospital. The NHS comes under pressure and has always done so. However, I believe that the additional resources of 6.6 per cent in real terms over four years for health authorities are extremely significant and will enable us to meet the pressures now being placed upon the service.

Lord Rotherwick: My Lords, will that significant increase of 6.6 per cent enable those community hospitals which were closed to be re-opened?

Lord Hunt of Kings Heath: My Lords, the noble Lord would not expect me to comment on each individual community hospital. Community hospitals and other facilities have a role to play--particularly as regards intermediate care--in allowing people to be discharged from district general hospitals for rehabilitation and then to go back to their own homes. I see a strong case for such facilities.

The Lord Bishop of Hereford: My Lords, does the Minister acknowledge that apart from the matter of adequate resources, there is another problem which concerns the announcement of further improvements in the National Health Service? Members of the general public, and in particular NHS staff, find it dispiriting to have announcements of more money, more consultants, more nurses and better services when such resources cannot be delivered overnight. Expectations are raised. It would be much more helpful if the Government were to announce improvements and place upon them a measurable and realistic timescale. I have been asked to put that point to the Minister by administrators in the local health service in Herefordshire who find that to be a particular problem.

Lord Hunt of Kings Heath: My Lords, I believe that it is much better that we are able to announce large increases rather than the small increases announced by the previous administration. It is right that we have a concerted plan to ensure that those resources are spent wisely and that there is a realistic timetable. That is what the NHS Plan is about: it sets out a realistic timetable for improving standards of services in the NHS and for increasing the number of staff available. I would be the first to accept that there is currently enormous pressure on staff in the health service, and the first to acknowledge the debt that we owe to them for the tremendous efforts that they make. However, at the end of the day the foundation for future improvement has to be the kind of resource increases which we have announced.

Lord Roberts of Conwy: My Lords, in view of the Minister's comments on the tendency of executives of trusts at this time of year to exaggerate their claims and woes, can he tell the House whether there are any signs of an underspend amid trusts this year?

Lord Hunt of Kings Heath: My Lords, the forecast for the end of the current financial year made at the

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half-way stage estimated that, overall, trusts in England forecast a deficit of approximately £9 million in total. At the same time, health authorities forecast a £45 million surplus. Essentially, based on those figures we would expect to end the financial year at a break-even position.

Lord Bruce of Donington: My Lords, does the Minister consider it proper that the National Health Service should be subject to the very pressures to which she refers when there are many other sections of the community, notably the richer, which suffer no stress at all?

Lord Hunt of Kings Heath: My Lords, at the end of the day the National Health Service is here to serve the whole of the population, and I believe that in so doing it does an excellent job. The NHS is under pressure. We want to make changes to improve services, and we are succeeding in that. I am convinced that the increases in revenue which have been given over the past few years and promised in the next few years will deliver the kinds of services that the public, quite rightly, expect.

Baroness Carnegy of Lour: My Lords, has it occurred to the Government that, given the generous increase of 6.6 per cent, trusts might well be able to put their affairs in order if they were allowed to do it in their own way, instead of having to meet all the centrally imposed targets on which they must concentrate?

Lord Hunt of Kings Heath: My Lords, that is the very reason the Government have introduced the concept of earned autonomy which means, essentially, that those trusts which do well will be given much more freedom to decide their destiny, while those which do not do so well can look forward to increased intervention. Surely, that is the appropriate way to proceed.

Pensions: Minimum Income Guarantee

2.44 p.m.

Baroness Castle of Blackburn asked Her Majesty's Government:

    What are the latest figures for the take-up of MIG (minimum income guarantee) by eligible pensioners following the Government's take-up campaign; what are the Government's plans for the future of the campaign; and what has been its cost to date.

The Parliamentary Under-Secretary of State, Department of Social Security (Baroness Hollis of Heigham): My Lords, the Government's MIG take-up campaign has so far resulted in over 82,000 successful claims. A follow-up exercise started in the week of 5th March to encourage claims from pensioners who might become eligible due to this April's increase in the

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MIG capital limits should again bring in more claims. To date, the campaign has cost approximately £9 million.

Baroness Castle of Blackburn: My Lords, is the Minister really satisfied with a situation in which the Government, having launched a massive take-up campaign directed at half a million people, by this stage can report only that 80,000-odd people have responded? Can the Government explain why people do not like means testing? I hope that the Minister will not say that they are too rich to benefit. Does the Minister realise that as a result of the pensioner credit the number of those on means-tested benefits will rise dramatically and something like 5½ million people whom the Government say will qualify for pensioner credit will become means tested? If the Minister cannot sell the present system to the potential recipients, can she hope to persuade 5½ million people to take up their due?

Baroness Hollis of Heigham: My Lords, I believe that that was a question, but I am not entirely sure. My noble friend pressed me on two points: first, the MIG take-up campaign; secondly, the implications of the pensions credit which is due to be implemented in 2003. I ask noble Lords to allow me to deal with both matters, although it may take a little while given the length of time taken by my noble friend in putting her questions.

First, I did not say that there had been 82,000 responses but that there had been 82,000 successful claims. There were 840,000 responses, approximately half a million of which were by telephone. Of those, 82,000 claims were successful. Claims were unsuccessful because the individuals had too much income or capital, which are issues that we seek to address in our subsequent developments. As for my noble friend's suggestion that this arises because of stigma, of the 470,000 people who replied to the MIG take-up campaign by telephone, only one-fifth knew that MIG was income support and of those the vast majority said that it did not matter. I do not accept my noble friend's argument that stigma deters people from claiming. People did not know that it was an income support benefit, and for the most part the reason they failed to be eligible was that they had too much income or capital.

Secondly, my noble friend referred to pensioner credit and the extension of means testing to 5½ million people. It is the case that under pension credit 5½ million people will enjoy both MIG and the protection of the modest occupational pensions that so many pensioners have in this country. My noble friend might have rejoiced with me that because MIG is earnings-related 55 per cent of all pensioners will in future effectively have their pensions earnings-related.

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