NHS Resources and Priorities

Part of the debate – in the House of Lords at 4:47 pm on 14th November 2000.

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Photo of Earl Howe Earl Howe Conservative 4:47 pm, 14th November 2000

My Lords, I begin by thanking the Minister for repeating the Statement which contains much that we can welcome. The sums of money that the Government have allocated to the NHS over the next three years are significant by any standards. We need to be clear that large parts of today's announcement represent allocations of part of the increased money for the NHS announced in the Budget settlement earlier in the year. Therefore, my welcome today is in part a repeat of the welcome given by the Opposition to that announcement some three months ago.

I am sure it is right nevertheless that we should be presented today with a greater measure of detail than was available in the summer. I particularly welcome the fact that a significant portion of the enlarged budget should be directed towards the drive to eliminate regional health inequalities, to help with nursing accommodation and to eliminate two of the most important of the country's killer diseases.

But the benchmark of success for the Government's good intentions will be the manner in which the money is spent and the health gains thereby achieved. I have several questions for the Minister. The Statement mentions that the real-terms increase in spending over the three years will be 6.3 per cent per annum. It also states that every health authority will benefit from a rise of at least 6 per cent in 2002-03 and a further increase of at least 6 per cent in the following year. Can the Minister confirm that the 6 per cent increases for health authorities in those two latter years represent cash increases and that health authorities can, therefore, expect to receive real-terms increases of some 3.5 per cent? Perhaps the Minister will tell me if I have misunderstood that part of the Statement. If it is only a 3.5 per cent real-terms increase, we have to be clear that, welcome as it is, it will do only a limited amount to address what is now a steeply rising curve in the healthcare inflation rate.

Perhaps I may also ask the Minister about the expansion in the number of beds. The beds to which he appears to refer in the Statement are beds in intermediate care. These are not hospital beds but beds which already exist in the private residential care and nursing home sectors. In that context, does the noble Lord share my worry? As I predicted when we debated the Care Standards Bill, we are now seeing a serious contraction of the private home sector as a direct consequence of two factors: first, the inadequate fee rates paid by local authorities; and, secondly, the blight caused by the uncertainty surrounding the Government's minimum standards legislation for care homes which we have still to see. What reassurance can the Minister give today to the care home sector that not only is it needed and wanted but also it will be properly and fairly remunerated for the work it does?

I turn to waiting times. Ministers have consistently adopted the public position that as waiting lists are reduced, so waiting times are reduced. I question, not for the first time, the logic and accuracy of that assertion. It is particularly noticeable that in the most recent set of waiting list figures the number of patients waiting over a year has increased from just over 30,000 in March 1997 to over 50,000 in September 2000. The number of patients waiting more than 26 weeks for an out-patient consultation has increased from 71,000 to 125,00 in the same period. There is an increase of 187,000 for those waiting more than 13 weeks for an out-patient appointment. The headline numbers of patients are coming down but many patients are waiting longer. Therefore, what change has there been since the Government came to office in the average in-patient and out-patient waiting times? Those figures seem to be better indicators than most of what real patients currently experience.

The key problem with waiting times, and specifically the pledges set out in the NHS Plan is the shortage of specialists to treat patients. The target, for example, of achieving by 2002 a maximum two-month wait from an urgent GP referral for suspected breast cancer to treatment of the breast cancer is regarded by many as unattainable because there will not be enough oncologists, radiologists, histopathologists and so on to ensure a swift enough diagnosis on referral. The year 2002 is not a long time away. I put this point to the Minister last week. I am not sure that he gave me a full reply. Perhaps he could do so now.

Finally, I turn to the funding announced for drug treatments. The additional sums to which the Statement refers are welcome although I noted with some surprise that both coronary disease and cancer are "largely preventable". That, I think, will be news to many. However, that is not my point. I refer to the role of NICE. By directing money specifically to cancer and heart diseases, the Government appear to be sending a strong signal to the National Institute for Clinical Excellence that one of the main criteria under which NICE operates--namely, the need to assess the effective use of available NHS resources--is, for practical purposes, redundant in those key areas. In that sense, the new funding distorts the remit of NICE. Drugs to treat cancer and heart disease are not to be assessed on a par with, let us say, drugs for diabetes, arthritis or Alzheimer's. In other words, the extra money looks as though it will serve to favour and prioritise cancer and heart drugs over other kinds of drug treatment even before NICE has considered those drugs in terms of their clinical and cost effectiveness. Indeed, why confer on NICE a duty to consider the wider affordability of drug treatments if at the same time you make such judgment redundant for certain classes of drugs?

I stress that I do not belittle the new funding for drug treatments. But perhaps I may ask the Minister whether, and on what basis, he is confident that this funding will serve to eliminate postcode inequalities in the prescribing of major heart and cancer treatments. Can he reassure us that the channelling of new money to help authorities will guarantee the availability of up-to-date drug treatments? It would be possible for me to ask many more questions of the Minister arising out of this wide-ranging and important Statement. However, in deference to the House I shall desist. I look forward to the Minister's response.