NHS Resources and Priorities

Part of the debate – in the House of Lords at 4:57 pm on 14th November 2000.

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Photo of Lord Clement-Jones Lord Clement-Jones Liberal Democrat 4:57 pm, 14th November 2000

My Lords, I, too, thank the Minister for repeating the Statement in this House. I share the views of the noble Earl, Lord Howe, that it is an important Statement. One would wish to ask many questions, particularly with somewhat longer notice than was available. This is a complex Statement potentially and a number of issues underlie what appear on the surface to be straightforward propositions.

On these Benches we have never made any pretence of doing other than welcoming the increased funding which was announced earlier in the year, or the essentials of the NHS Plan which are designed to spend the increased funding. We welcome many elements of the Minister's Statement: in particular, the fact that it is now possible to announce a three-year funding settlement; the fact that the settlement is directed towards resolving health inequalities; and the funding for cancer and heart disease which are at the top of the priorities for the Government and for all of us.

I share the noble Earl's views that it is essentially a Statement of allocation. This is not new money. It is the Government telling us in greater detail than was available earlier in the year how the money is to be spent. On these Benches, we also welcome the cost-of-living supplements for nurses and those in allied professions in London, the Home Counties and the South West, and the announcement of the NHS implementation plan. But Ministers should not over-egg the pudding. There are question marks about the performance to date of the NHS. There was a congratulatory tone about the Minister's Statement which many of us felt was inappropriate in the circumstances. Effectively, we are talking about a statement of what is planned to be spent, not patting ourselves on the back on what has been achieved to date.

The Healthcare Navigator figures reported today--I should like to hear today why the Government dispute them--put in question Ministers' claims on waiting time performance, particularly in the South East. The personal experience of many in this House indicates that those figures ring truer than many of the statements made by the Government.

So there are a number of questions over the Government's Statement today, about the figures they have quoted and their allocation. I wonder how the Government can be quite so specific today: they have made very clear statements about percentage rises, but we do not yet know what the pay settlements will be. At the moment we do not know what the pay settlements for doctors and nurses will be, and, after all, pay accounts for 70 per cent of NHS costs and normally settlements are not agreed until Janauary or February. Can the Minister confirm that health authorities will have certainty earlier than usual? Will those pay settlements be agreed in the next few weeks?

It is also important to know just how much money the NHS is retaining at the centre. We have seen a pattern over the last few years where, by means of modernisation funds and other funds, the full amount of the allocation is not made available to health authorities. Strings are attached to a number of different forms of expenditure. The Government, by announcing their implementation fund, have done almost exactly the same thing this year. It would be helpful if the Minister could say exactly what is being retained at the centre and what will suddenly be announced later this year as part of a new initiative which is no doubt already planned. It would also be helpful to know what precisely is ring-fenced by health authorities. Quite often we hear announcements of additional funding for, say, dentistry, but is it really additional funding? Indeed, is it ring-fenced? Are health authorities obliged to spend the money? None of this is entirely clear.

The noble Earl, Lord Howe, referred to NICE making decisions over a huge number of treatments over the course of the year, whether through the guidelines for which it is responsible or through its appraisals. As your Lordships know, a number of appraisals are eagerly awaited, not least the appeal process on Beta Interferon which is in train at this moment. Will the funding be there? Has the calculation been made about the anticipated cost of those treatments and their implications for health authorities? I am sure that health authorities would like to know.

We congratulate the Government on the fact that drugs like Taxol and Taxotere have been funded by health authorities. Will health authorities be able to continue with such funding? There is little time in which to raise other topics, such as intermediate care. Will that be health authority funded or social services funded? The Government have pledged to pay for nursing care by October 2001. Will that be done through health authorities or social services? What will be the deficits of health authorities by this year-end?

The Statement raises a huge number of questions. It has come at very short notice and at the end of the day the important question is: will authorities have the capacity to spend the money which has been allocated to them? Capacity is at the core of the NHS. We know there will be a winter crisis this year. Will there be crises in winters to come?