NHS Modernisation

– in the House of Commons at 3:30 pm on 15th March 1999.

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Photo of Frank Dobson Frank Dobson The Secretary of State for Health 3:30 pm, 15th March 1999

Much of the national health service that we inherited from the previous Government was run down and shabby. Much of its investment in information technology had been an expensive failure. Much of its equipment was unreliable and let down both patients and staff. Patients waiting on trolleys had become a commonplace feature of the service. That is why one of the top priorities of the new Government is to modernise the national health service, build new hospitals, replace outdated and unreliable equipment and give patients quicker, easier and more modern access to health services.

We are already committed to investing an extra £21 billion in the NHS over the next three years. The biggest hospital building programme in the history of the health service is already under way. This coming year, at least £350 million will be invested in upgrading and replacing outdated equipment.

Today, I can give the House details of an additional £200 million to be invested in the coming year to speed up our programme to modernise the health service. That is made up of £100 million to be invested in modernising accident and emergency departments and, drawing on the example of NHS Direct, in improving rapid access to professional advice and help for patients. The second £100 million will come from the national lottery and will be used to step up the fight against cancer by helping to provide new and replacement equipment, such as linear accelerators, diagnostic machines and scanners, as well as extending the services provided by hospices. What better use could there be for national lottery money?

Earlier this year, I was able to announce that £30 million was to be invested to improve 79 accident and emergency departments around the country. That will be funded from the NHS modernisation fund. Last Tuesday, my right hon. Friend the Chancellor announced in his Budget that £430 million from the Government's capital modernisation fund had been earmarked for investment in the NHS, and that £100 million of that would be made available this coming year to modernise the health service. Between £70 million and £80 million of that money will be invested to modernise all those A and E departments that remain in need of improvement.

Those improvements will include special areas for children and easier access to X-ray, pathology and pharmacy services. The layout and furnishing of A and E departments will he improved to make them more pleasant and more secure. Video surveillance and alarm systems will bring greater efficiency and add to the security of both patients and staff. Some modernised A and E departments may incorporate an NHS Direct telephone point. All A and E departments that need improvement will benefit from some or all of those changes.

A survey by the Royal College of Physicians published early in 1997, before the last election, showed that less than half the hospitals with A and E departments had an admissions ward. Since that survey, the number of such hospitals without either an admissions ward or observation unit has been reduced to 22 out of 202. By the end of this initiative, only five will not have an admissions or observation unit—and all five have good hard reasons for not having one.

Proposals that are likely to be funded under the new accident and emergency initiative include the extension of the children's service at Royal Liverpool hospital and improvements at Sheffield children's hospital and in children's facilities at North Staffordshire hospital. In Ipswich, a major scheme includes improvements to resuscitation facilities and a separate children's area, and in Luton there are to be more resuscitation facilities and closed circuit television.

A total of £250,000 worth of improvements are intended at the Royal London hospital in the east end and a similar sum is to go to the Mayday hospital, Croydon. Large-scale improvements are intended at Southampton general hospital and a new observation unit and better facilities for the general practitioner co-operative are planned for Frenchay hospital, Bristol. Those are just a few examples of what is planned for hospitals in every part of the country.

This is the biggest programme of investment in accident and emergency services in the history of the NHS and it will cover every part of the country. By April 2000, every A and E department will have been modernised, or work will be well under way. It should ensure that patients are treated more quickly, more effectively and with greater privacy than ever before.

I am determined to ensure that both patients and staff get maximum benefit from the accident and emergency modernisation programme, so it is not just a matter of new buildings, new plant and new equipment. We have to ensure that the new and better ways of organising accident and emergency, such as emergency nurse practitioners and greater use of telemedicine, are taken up throughout the country. We need to speed up the spread of best practice, so I am setting up a team of professionals to spearhead that work. I can announce today that the team will be led by Mike Lambert, accident and emergency consultant at Norfolk and Norwich hospital.

The accident and emergency modernisation programme will be good not only for patients and staff, but for jobs—for builders who do the work on site and for firms that supply building materials and specialist fittings. Let me give just one example. The accident and emergency department at Portsmouth has just been refurbished at a cost of just over £1 million. It used materials that were supplied by more than 20 firms from all over the country. Orders, large and small, included locks from Walsall, paint from Darwen, weather-proofing from Slough, carpets from Swindon, wash basins from Rugeley, partition walls from Loughborough, wall units from Broadstairs—and the specialist security reception desk came from Glasgow. The accident and emergency modernisation programme will reflect such orders a hundredfold in the coming year.

The remainder of the £100 million from the Government's capital moderninisation fund will be invested in improving direct access to the health service. The popularity of NHS Direct, the nurse-led 24-hour helpline, has demonstrated the public demand for rapid direct access to professional advice and help from the NHS. Following the success of the pilot schemes, NHS Direct has already been extended since Christmas to cover 5 million extra people in the black country, Essex, Nottingham and west London, and will cover 20 million people by Easter. Its success has shown that, given the chance, the talented staff of the NHS can do a brilliant job, supplying what the public want. We are now considering an NHS on-line service to provide a website with on-line access to a wide range of health information.

Between £20 million and £30 million is being made available in the coming year to finance capital investment in further developments in direct access to the NHS, including pilot schemes for walk-in services. Those could include services that are provided by GPs or practice nurses located in or near A and E departments, out-of-hours services provided by GP co-operatives, and services in main streets or shopping malls.

As with NHS Direct, we want to work with the professionals to try out direct access, walk-in services in places and at times that are particularly convenient to patients. Some schemes may be confined to providing advice or directing patients to existing services for treatment or care. Others, particularly those associated with A and E departments, may provide treatment and care, there and then. That is intended not to replace general practice, but to augment it. All those ideas will go with the grain of both modern living and what the health professionals are already developing. The new Government are determined to give impetus to all that to help to create a new NHS for the new century.

That brings me to the extra £100 million that will begin to be invested in the coming year to augment existing NHS investment in the fight against cancer. In line with our election promise, we have set up the new opportunities fund to ensure that more money from the national lottery is spent on the causes on which people want it to be spent. Every time there is a discussion about what to do with lottery money, thoughtful people ask why some of it is not being used to combat cancer. Well, from now on it will be. Over the next three years, £150 million from the new opportunities fund will be invested in tackling cancer in the United Kingdom as a whole. In England, we want to make a major start this year by investing in new equipment.

The order making that possible was laid last week by my right hon. Friend the Secretary of State for Culture, Media and Sport. The direction that he issued at the same time makes it clear that the focus of the initiative in England will be on augmenting voluntary efforts to raise funds to provide new and better equipment, including breast-screening units, scanners and linear accelerators, and also on helping hospices and those providing palliative care. The aim is to provide additional equipment and to replace unreliable equipment. The money is likely to help to fund, for example, replacement linear accelerators at Christie hospital in Manchester, or new equipment for the diagnosis and treatment of cancer of the colon at Lewisham hospital, which my right hon. Friend and I visited this morning.

All that money comes on top of the extra funds already announced for the NHS, and will help the NHS in every part of the country to catch up with more modern standards of cancer diagnosis and treatment. The initiative has the strong support of Macmillan Cancer Relief, Marie Curie Cancer Care and the National Council for Hospice and Specialist Palliative Care Services. It is in addition to the extra £30 million that we have invested in breast and colorectal cancer services over the past 18 months, the further £40 million that we are making available in the coming year to combat breast, colorectal and lung cancer, and our commitment to speeding up specialist attention for people suspected of suffering from cancer.

The commitments that I have announced today will speed up the renewal and modernisation of the health service. They will make services more readily available and more dependable. At the same time, they will make it easier for the dedicated staff of the health service to provide quicker and better-quality services. That is possible only because we have a Government who invest public money wisely, and who have the right priorities.

Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald

I feel that the House would appreciate it if, before I deal with the detail of the statement, the Secretary of State explained how yet another of his Department's statements was leaked to the media before being delivered to the House.

Those of us who were up at the time will know that the 6 am news on Radio 5 Live contained a detailed report on the setting up of admissions wards in hospitals, which could have resulted only from a detailed knowledge of the contents of the statement. It also appeared on BBC teletext. The nurses' pay award statement was leaked to the press two weeks before publication. The Ashworth hospital statement was leaked to The Daily Telegraph one day before it was made to the House. The mental health statement was leaked to The Sunday Telegraph two days before publication. The social services statement appeared in The Independent and The Guardian on the morning of publication. The children's safeguards statement appeared in the Evening Standard on the morning of publication. The health spending statement, made in March 1998, appeared in The Times on the morning of its delivery to the House.

Is it not high time that the Secretary of State lived up to the undertaking that he gave the House in November 1998 to find the person responsible for that brazen contempt of Parliament, and to have that person dismissed? Perhaps he could tell us what progress he has made on that one.

In the course of the right hon. Gentleman's statement, he kept referring to the "new" Government. I should say that, after listening to the statement, the "new" Government are looking pretty old: old money recycled as new announcements, and old announcements reannounced. There was very little that was new in the whole statement. Will the right hon. Gentleman therefore tell us how much money has been taken from the so-called modernisation fund to fund the nurses' pay award? Did not the Government's own statement on the modernisation fund, in July 1998, say that the fund was intended for waiting lists, capital investment, education, staff training, primary care and mental health? Why, therefore, is it being used to fund regular expenditure on pay? If he plans on saying that the fund was always designed to do that, will he give the House a simple guarantee—that no project will be delayed that was to be funded from modernisation money in order to pay the nurses' pay award? Will he give us that simple guarantee?

Does the right hon. Gentleman also remember the Labour party's pledge in 1996 to establish a task force on trolleys and to monitor the number of patients forced to wait for treatment in that manner? Why has he broken that pledge? Is he not now essentially telling doctors how to manage their hospitals by requisitioning wards for use as a temporary stopping place for patients? Is he really satisfied that that is the best use of such space, given the strain that our hospitals are under?

Would not a better solution to the problem of patients waiting on trolleys be to abandon the right hon. Gentleman's damaging waiting lists initiative, which has resulted in hospitals continuing to admit routine waiting list cases even though accident and emergency wards had patients stacked up on trolleys this winter? Does he agree with the view of Dr. Simon Fradd, deputy chairman of the British Medical Association GPs committee? He said: These well-intentioned but ill-informed initiatives put huge pressure on hospitals … there is a downward spiral of reduced resources and increased waiting times"?

Would the right hon. Gentleman care to calculate how many times now he has re-announced the modernisation fund and NHS Direct? Does he agree that he has been forced to do so again because, despite the huge tax take of the past three years, all he has to announce to the House today is an extra £100 million? Is that why we are not getting a proper Budget debate on health?

How many patients were left lying on trolleys because of this winter's health service crisis? Will the right hon. Gentleman guarantee that the dedicated wards that he has announced today will not reduce capacity elsewhere in hospitals? I should like a very clear answer to that question: in setting up those wards, will he be reducing capacity elsewhere?

On 9 November 1998, after the pre-Budget announcement, the Secretary of State announced £200 million expenditure. The NHS Confederation, however, said: This is really only next year's money paid early so that we can implement schemes that will save money". Was it correct? Is the money that is being announced today really new money?

Has the right hon. Gentleman come to any conclusions on how NHS Direct—he has not told us today—will be organised nationally? National centres are likely to be more efficient and lead to more uniform standards, but may reduce co-ordination with local GPs, whereas local centres based in practices may lead to a lack of uniformity in standards. Will he take this opportunity to reassure GPs that the pilot scheme in Northumberland, which routed all out-of-hours calls to NHS Direct, will not be extended—as has recently been speculated—to cover in-hours calls, too? Given that today is, by my calculation, the third time on which he has made a statement on NHS Direct, surely he has now had the chance to form more detailed opinions on how the scheme will work in practice, rather than merely giving us vague words and principles.

Will the right hon. Gentleman confirm that any measures that he intends to put in place—including those announced today—to prevent a repeat of this winter's chaotic scenes of patients on trolleys will not, this time, be left until the last moment? Has he finally learned this winter's lesson—that money and schemes announced at the last minute, to grab topical headlines, do not produce much for the NHS? The winter, after all, is predictable.

Does the Secretary of State agree that next winter, trusts will be under greater pressure than ever as they struggle to adapt to his upheaval in primary care? What allowances is he making for that? Will he put money in place to ensure that the burden of extra bureaucracy imposed on the health service by his reforms does not reduce levels of patient care, as his waiting lists initiatives have done?

The right hon. Gentleman referred again today to £21 billion of extra money. Will he answer this simple question—so simple that I am sure that he has the answer at his fingertips? What was the total level of spending on the national health service for the financial year 1998–99 and what is the planned level for the financial year 2000–01? What is the difference—I can supply an abacus if he cannot manage the sum—between the two?

The Secretary of State concentrated heavily on the provision of new equipment to combat cancer. Does he agree that one of the main problems is the shortage of radiographers? Why is he concentrating on equipment? What plans does he have to address the shortage of radiographers?

The Secretary of State says that he is drawing his expertise from the Norfolk and Norwich hospital. I seem to recall that that hospital's imaginative solution to the winter crisis was freezer vans in which to stack the dead. He will note that the Portsmouth example that he gave will cost £1 million, yet he claims that the £70 million to £80 million that he has budgeted for will cover all accident and emergency adaptations. Is he saying that there are relatively few such adaptations left to make? If not, how will he afford them from that sum?

Finally, what progress have the Government made towards realising the Secretary of State's target of a maximum two-week wait to see a specialist after an urgent written referral for suspected breast cancer?

Lastly—[HoN. MEMBERS: "Oh!"] Well, finally and in conclusion rather than just finally. As the Secretary of State has mentioned the NHS in shopping malls, will he acknowledge his debt to the private sector, which pioneered that practice?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I shall try to answer as many of the right hon. Lady's questions as I can. She was a trifle inconsistent in her opening remarks, claiming that the matters that I was disclosing today had been disclosed earlier on television and radio and then saying that I had not said anything new. All the money is new money for the national health service because the Treasury funds had previously not been earmarked for the health service. They have now been earmarked. The £100 million from the lottery—to which the right hon. Lady made no reference, unless my ears were deceiving me—is certainly new money for the NHS and will be welcomed by all concerned.

The modernisation fund has many aspects. I announced that part of the nurses' pay award would be funded from the modernisation fund. That is not something that some Tory sleuth managed to spot. I drew attention to the issue myself because we had made prudent allowance for the fact that we needed extra money to pay the nurses to catch up with the pay that they lost during all the years that the Tories were in office.

The right hon. Lady talked about problems with radiographers. Radiographers cannot be trained in 10 minutes; they do not grow on trees. If there is a shortage of radiographers now, it is because they were not trained at any time during the 18 years that the Tories were running down the national health service.

The right hon. Lady appears to think that there is something wrong with wanting every accident and emergency hospital to have an admissions ward. If she wants to quarrel with that, she should talk to all the accident and emergency specialists and to the Royal College of Physicians, whose proposals we are putting into practice. The Tories did not get on with them as quickly as they should have done.

The right hon. Lady referred to the Norfolk and Norwich hospital. It is certainly true that because so many people in the area died, the hospital did not have enough space in its mortuary to keep bodies. It had to do something to cope, and just because some ignorant hysterical newspapers decided that that indicated that something was wrong with the NHS, the right hon. Lady should not go along with it. One of the problems was that private sector undertakers were not burying or cremating people as quickly as they should have been, so the numbers built up.

The right hon. Lady referred to the work carried out in Portsmouth, which cost just over £1 million. Some of the schemes that I have announced today will cost as much, but many will cost much less. We are bringing all the A and E departments up to the necessary standard, in line with what local people want.

The right hon. Lady referred to NHS Direct, which has been a dramatic success story. If the professionals in any locality want the scope of NHS Direct to be extended to involve them more, we are willing to accept that, provided that we are convinced that the local NHS Direct can cope. No Government or Opposition should try to stand in the way of that; nor should any national representative body wish to stand in the way of developments requested by local professionals.

On the point about national or local call centres, my view is that we do not want a national call centre, but a limited number of local, or sub-regional, call centres so that people have a sense of ownership of that part of their local NHS.

I return to the point that the right hon. Lady managed to skirt around—that, as a result of my announcements today, more than £100 million will go into modernising A and E departments, and that £100 million from the national lottery will go into improving the diagnosis and treatment of cancer. I thought that she might have got around to welcoming that.

Photo of Mr Peter Pike Mr Peter Pike Labour, Burnley

Does my right hon. Friend accept that millions of people prefer to hear good news Frank rather than whingeing Ann? Does he recognise the problems in Lancashire at the central hub unit for kidney treatment at Preston, and the satellites in Lancashire? Could additional resources be used to deal with a problem that we inherited from the previous Government?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I thank my hon. Friend for his welcome. I know that the local health authority and the trusts in the area are looking at how they can better organise kidney services. When I visited Chorley and Preston, I met people from the Lancashire ambulance service, who operate the call side of the NHS Direct pilot. The nurses in Chorley hospital—who provide the advice—are up for what we are proposing, and they are willing to extend their activities to cover other parts of north Lancashire.

Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Health)

The £100 million more for accident and emergency services, and for accident and emergency admissions wards is welcome. Will all the A and E department wards be extra wards with extra beds, rather than redesignated wards with redesignated beds? Will he undertake to the House that in a year's time, when the programme is complete, there will be enough consultants, doctors and nurses to staff those wards?

We do not give such a welcome to the £100 million for cancer services. Does the right hon. Gentleman accept that it is not reassuring but worrying to hear that, instead of what the Government see as a core part of the NHS programme—the treatment of people with cancer—being funded through the taxpayer by secure NHS funding, for the first time core NHS equipment, such as scanners and linear accelerators, will be funded not by the taxpayer, but by an uncertain revenue from the national lottery? Would not it have been better to secure funding for the health service before taking a penny off income tax and making the NHS dependent on insecure funding from national gambling?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

That was a limited welcome, I suppose. One of the advantages of modernising A and E departments and giving them full facilities is that it makes life easier for the staff and allows them to do their jobs properly. If an accident and emergency department does not have its own X-ray, or the pharmacy is miles away, or the trauma unit is somewhere else, it is very difficult for staff. We are trying to make departments more efficient and place fewer, not greater, demands on staff.

Whether the hon. Gentleman likes it or not—and whether I like it or not—huge amounts have come from the voluntary sector, rather than the national health service, for capital cancer equipment, especially with the development of scanners throughout the country. All that we are saying is that when, as in Lewisham, there is a local campaign trying to get together a few thousand quid to improve the service, we will put some lottery money in to match it or more. If he thinks, as the Conservative Government did, that it would be better to subsidise Eton college boating and athletics facilities or to give 24 million quid to the Churchill family, I will back my judgment that the public prefer our spending on cancer treatment.

Photo of Fiona Mactaggart Fiona Mactaggart Labour, Slough

Does my right hon. Friend agree that the people of Slough, who are about to have a new accident and emergency facility, will be thrilled with his announcement? We do not have people waiting on trolleys, because there is not enough room for them in the present accident and emergency department, so they wait in ambulances on the forecourt, causing delays in the local ambulance service. I hope that the extra money will mean that we can have separate accident and emergency facilities for children.

Tory Members sneered when my right hon. Friend spoke about how the work in the Portsmouth accident and emergency department will bring new jobs. Does he agree that people who are employed have better health records than the unemployed and poorer people and that the Government's economic policy, making people more prosperous in work, will give us a healthier Britain?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

Indeed; I thank my hon. Friend for her welcome. I hope that the proposals will be implemented swiftly and effectively. I have heard Tory shadow Ministers and Back Benchers ranting on about the loss of jobs in manufacturing industry, but immediately I draw attention to how manufacturing jobs are being created by the investment in the national health service, they are reduced to mockery. Thousands of people throughout the country will get jobs as a result of the modernisation schemes. I am sure that they will welcome them and that, as my hon. Friend says, they will be healthier as a result of having a job and some decent wages in their pocket or handbag.

Photo of Michael Jack Michael Jack Conservative, Fylde

May I endorse what the hon. Member for Burnley (Mr. Pike) said? The time for talking is at an end, and kidney patients in Preston need action.

Will there be a review of the staffing requirements of those accident and emergency departments that will not benefit physically from today's announcement? Pressure on consultants and nursing staff often causes as many problems as inadequate physical capacity.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I repeat what I said to my hon. Friend the Member for Burnley (Mr. Pike): the provision of kidney treatment in Burnley, including that in the right hon. Gentleman's constituency, is being carefully considered. He mentioned Preston hospital, and the nurse-manager of that hospital was made a dame in the New Year's honours list and is going to the palace today or tomorrow.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I am answering the question. The management of Preston hospital have managed it so well that here has never been a significant shortage of nurses. They have also provided the back up for NHS Direct. They run their hospital rather better than the managements of some of the hospitals nearby. Although there are some problems, it is clear—as even the odd Conservative might recognise—that the quality of management, and whether they involve and encourage their staff, can help to reduce staff shortages. That is what has been done successfully at Preston hospital.

Photo of Edward O'Hara Edward O'Hara Labour, Knowsley South

Will my right hon. Friend join me in appreciating the excellent work of accident and emergency staff at the St. Helens and Knowsley hospitals, especially Whiston hospital in my constituency? Its new A and E department opened five years ago and, in the recent troubles elsewhere in the region, stood out as a beacon of excellence in coping with the winter problems. However, because of various problems—including closure of nearby facilities and the new accessibility of the hospital as a result of the new Knowsley expressway—extra pressure is already being put on that department. Will my right hon. Friend make funds available, from this tranche of money or the next, to extend the admissions observation ward facilities at Whiston hospital and to provide a care facility for self-referrals, which are adding to the more than 100,000 patients who pass through the A and E department every year?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I thank my hon. Friend for thanking the staff at his local hospital for the excellent job that they do. We must ensure that, as circumstances—the layout of motorways, the erection of new houses, or people doing dangerous jobs that cause more accidents—change, we have an accident and emergency system that responds adequately. I will look into the points that he raised about his local hospital.

Photo of Eric Pickles Eric Pickles Shadow Spokesperson (Work and Pensions)

The right hon. Gentleman mentioned several projects that would benefit from the reallocation. He did not mention Oldchurch. Was that an oversight? Surely, nothing is more deserving than the replacement of Oldchurch hospital, which the Secretary of State himself described as "sub-standard". When will work start on the new hospital for Oldchurch and when is it likely to be completed? We have been waiting six months from the date that we expected to receive an announcement.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

Oldchurch hospital did not become sub-standard through the wave of a magic wand on 1 May 1997, nor has it been run down especially since then. It has been run down over a long time, and we will replace it. If the hon. Gentleman possesses his soul in patience a little longer, he will get an announcement.

Photo of Sylvia Heal Sylvia Heal Labour, Halesowen and Rowley Regis

I welcome, on behalf of the health authorities of Dudley and Sandwell, my right hon. Friend's statement. The staff who work in the A and E departments in the local hospitals will greatly appreciate the fact that he has acknowledged their work and the need for extra funding. Will he join me in congratulating the staff of NHS Direct in the black country? I visited the service on Friday—it is part of the West Midlands ambulance service—and discovered that it had taken 3,600 calls in February alone. The commitment and enthusiasm of the nurses who staff the line are greatly to be admired. Will my right hon. Friend assure me that he will ignore the Conservatives' comments and continue to provide innovative ways of delivering a national health service to the people of this country?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I thank my hon. Friend for her comments. The Conservative party seems unable to make up its mind whether it likes NHS Direct or not. I like it, and the public like it. It works, and it works better than anything that the Tories introduced.

Photo of Andrew Lansley Andrew Lansley Vice-Chair, Conservative Party

Will the Secretary of State confirm that he referred in his statement to two sums of money? On the first—the £100 million from the capital modernisation fund—will he confirm that page 67 of the "Financial Statement and Budget Report" makes it perfectly clear that that is not new money? Will he tell us how much of that £100 million was intended to be spent in 2000–01, and is, therefore, simply re-phased expenditure rather than new money?

Secondly, on the money from the national lottery, does the Secretary of State agree that everyone will be pleased to see money going into cancer treatment, but that there is a problem over the method of allocation of that money? There is great concern that, because the money is being directed through the NHS, it will not be additional money, while the national lottery should provide extra expenditure. Would it not be better if cancer care charities such as Marie Curie Cancer Care or the Macmillan nurses could provide the means by which to direct that money? If provided in that way, the money would be additional and would provide the multiplier effect on the effort to raise money to which the Secretary of State referred.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

The very organisations to which the hon. Gentleman referred have welcomed what we are doing. They will be heavily involved in the allocation of funds, and we want to involve all voluntary organisations that raise money locally. It is not a bad idea to have money going into the health service in line with NHS priorities, and we believe that the method chosen is the soundest way in which to provide it. The money is additional.

The hon. Gentleman's other point was whether the extra £100 million for accident and emergency or direct access services was new money. Simply, it is. That money was not included in the comprehensive spending review for the health service.

Photo of Andrew Lansley Andrew Lansley Vice-Chair, Conservative Party

It was in the comprehensive spending review.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

No, it was not. Some £430 million has been earmarked from the generalised Treasury modernisation fund for use by the health service over the next three years. Of that £430 million, £100 million is being made available this year. That money is additional to the funds that had been announced previously for the health service.

Photo of Mr Syd Rapson Mr Syd Rapson Labour, Portsmouth North

I thank my right hon. Friend for visiting Queen Alexandra hospital in Portsmouth recently. Everyone there praised him for providing money for a refurbished accident and emergency unit. Staff there will take the money, wherever it comes from. It is small minded and churlish not to grab the money with both hands and to welcome it.

My right hon. Friend's visit was hijacked to some extent, however, by the issue of Haslar hospital, Gosport. The hon. Member for Portsmouth, South (Mr. Hancock) is not here, but I am sure that he would say that that hospital's A and E unit also needs extra money following a period of having been run down. I hope that my right hon. Friend can say something in support of that hospital, but we welcome his statement today.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

The first hospital that I visited after I became Secretary of State for Health was the Boothroyd centre in Dewsbury, which goes to show, Madam Speaker, what a total creep I can be. The second was Queen Alexandra hospital in Portsmouth, which had a run-down accident and emergency department. It was a disgrace that the staff were expected to perform their valiant service in such conditions. It was there, too, that I met a nurse whose face had been slashed open by a yobbo who attacked her while she was trying to help. That is one reason why I have been so committed to trying to make life more safe and secure for those who work in accident and emergency departments.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

The hon. Gentleman may say that, but representatives of the British Medical Association tell me that they stopped talking to the previous Government about doing anything to improve security because Ministers used to tell them, "That's the sort of society we live in these days." [Interruption.] But it is truthful.

My hon. Friend the member for Portsmouth, North (Mr. Rapson) referred to the closure of Haslar hospital, which has been decided by my right hon. Friend the Secretary of State for Defence. As I made clear on the day of my right hon. Friend's announcement, we owe it to the people of Gosport to ensure that top-quality services are available for them there. They should not be expected to rely for the bulk of their services on going to Portsmouth, which is a fair stride away if one needs urgent treatment.

Photo of James Paice James Paice Shadow Spokesperson (Environment, Food and Rural Affairs)

How many extra beds will be created in our acute hospitals as a result of the right hon. Gentleman's announcement about the creation of admissions wards? Or is it simply a redefinition of beds that are already there, under another guise?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I cannot tell the hon. Gentleman the figures because all the details have yet to be worked out. In due course, that information will become available. As the hon. Gentleman ought to know, accident and emergency professionals and the Royal College of Physicians think that, even if some beds that were used for something else are used in an admissions ward, they will be being better used and the total benefit to patients will be greater than if they were not so used—[Horn. MEMBERS: "Ah!"] Some will be entirely new, some will be new and additional and others will not. I am not pretending that everything is additional—I am not as silly as Conservative Members apparently are.

Photo of Helen Southworth Helen Southworth Labour, Warrington South

In view of the additional resources that my right hon. Friend has announced, may I offer him best wishes not merely for a happy birthday but for many happy returns to this House with more announcements of that type? Is he aware that, in the last few months of the Tory maladministration, ambulances were queuing up outside Warrington hospital with patients inside them waiting for admission to the accident and emergency unit? Will he assure me that Warrington hospital, which provides an accident and emergency service for the entire north Cheshire region and which has no adequate medical assessment unit, will receive some of the resources that he has announced? That would make the people there, who work extremely hard, very happy.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I can say that the proposals for improvements to accident and emergency services at Warrington hospital are among the biggest of the projects that will be covered by my announcement.

Photo of Desmond Swayne Desmond Swayne Conservative, New Forest West

Given the importance that the Secretary of State has rightly attached to expenditure on cancer care, will he confirm that the Government have abandoned the principle of additionality for lottery money?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

No. I should explain that this money is additional to the money that the taxpayer is finding for cancer treatment and also additional to the charitable funds collected by all sorts of civic-minded people throughout the country, who want their local services improved. Therefore, it is additional in two respects—additional to taxpayer's money and to voluntary money. Combined with the other two, the additional money will lead to substantial improvements in the diagnosis and treatment of cancer. Most people will agree that that is additionality, and they will welcome it.

Photo of Mr Bill O'Brien Mr Bill O'Brien Labour, Normanton

I express my appreciation to my right hon. Friend for his statement and I appeal to him to extend NHS Direct throughout the region so that we can have the benefit of that service. May I also express appreciation on behalf of the people who work at Pinderfields general hospital in my constituency and at the Pontefract general infirmary, which serves my constituency, for the introduction of a scheme that will improve the accident and emergency units in those hospitals? The two units are very good, but I am sure that there is room to extend the facilities to help the patients who use them. Will my right hon. Friend undertake that the admission wards will be single sex? Unisex wards could cause difficulties because people are demanding privacy. Will he take that into consideration?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

We are committed to getting rid of, rather than introducing, mixed-sex wards. I hope therefore that all the additional facilities will be single sex. West Yorkshire will go on-line with NHS Direct early in April, and I will be there to do the opening ceremony.

Photo of Dr Peter Brand Dr Peter Brand Liberal Democrat, Isle of Wight

There appears to be a further extension of the scope of NHS Direct. Do NHS Direct services have to fit in with the health improvement programme determined by local authorities, to be delivered by primary care groups, or is a parallel primary care system being established? Is NHS Direct so named because it gives patients direct access to the NHS or because it allows the Secretary of State to have direct control over medical services?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

The hon. Gentleman—as he is a doctor I shall call him hon. and learned—is usually a bit better than that.

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

The hon. Member for Isle of Wight (Dr. Brand) will be mortified to know that the Member for Rutland and Melton (Mr. Duncan) thinks that he asked a good question; he may want to withdraw it. The fact is that NHS Direct gives people direct access at any time of day or night to a professionally qualified nurse skilled in the computer protocols and giving help, advice, reassurance and, in some cases, immediately summoning an ambulance. I am not directing it. I am pleased as Punch that I played a part in introducing it. It is direct access. That is what we believe in. All the other schemes that we are talking about are intended to augment the existing system and are carried out only if local people want them. We want to encourage local initiatives.

For further confirmation, I will say again, as I always do, that the general practitioner system is one of the glories of the NHS and of our approach to health care. We want to maintain and sustain it. All that we are doing is additional. We do not want to get in the way or undermine it. Many of the people who are bringing about those developments are GPs who see them as a way of extending the impact of general practice.

Photo of Jeremy Corbyn Jeremy Corbyn Labour, Islington North

I congratulate the Secretary of State on doing well in dragging money out of the Treasury to improve accident and emergency departments all over the country. He will also be aware of a problem that exists in the area that he and I have the honour to represent: inappropriate use of accident and emergency services by people who have difficulty in getting on to GPs' lists. They are often homeless or live in hostels or are in housing difficulty of some sort. What is he doing to improve inner-city GP services to ensure that GPs, rather than accident and emergency centres, are the first port of call for people with minor ailments and injuries?

Photo of Frank Dobson Frank Dobson The Secretary of State for Health

I would make two points. On improving GP services, when Sir Leslie Turnberg, a past president of the Royal College of Physicians, did his report on health care in London, 50 per cent. of inner London GP premises were substandard. The figure is now down to 33 per cent., and we are determined to keep up that progress.

Secondly, I differ with my hon. Friend about his reference to inappropriate use of accident and emergency departments. Feeling off colour may not be an accident or emergency but, as he knows, in many inner-city areas, people in such circumstances have traditionally gone to the local hospital for treatment. We want to ensure that the NHS responds appropriately to their needs by providing GP services, or on-call services at the A and E department, so that it does what local people want and meets local demand without an adverse impact on the provision of accident and emergency services. The health service must meet the needs of people and mould itself to local needs, not insist that local people mould themselves to the NHS.