National Health Service

Part of the debate – in the House of Lords at 2:13 pm on 9 March 2006.

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Photo of Lord Warner Lord Warner Minister of State (NHS Delivery), Department of Health, Minister of State (Department of Health) (NHS Delivery) 2:13, 9 March 2006

My Lords, if the noble Lord were to wait patiently, he would hear the rest of the story. I hope that he will wait patiently while the rest of the story is unfolded for him.

We have put up spending from £34 billion a year in 1997 to £90 billion by 2008. There are 27,000 more doctors and 79,000 more nurses since 1997. I hope that no one on the Benches opposite is suggesting that patient care can be improved without having more doctors and nurses. Waiting lists are at their lowest point ever. Since last month, no patient has been waiting longer than six months for their operation, with the average wait now about eight weeks. These are some of the results that have been produced by the extra investment. Some 99 per cent of people with suspected cancer are seen by a specialist within two weeks of referral by their GP, and since 1999 we have recruited nearly 1,000 extra cancer consultants. Patients now have a choice of four hospitals or clinics for their elective surgery; early deaths from cancer are down by 14 per cent, and for coronary heart disease they are down by 31 per cent. These death rates, along with the suicide rate, continue to fall.

I suspect that if you were to ask most of those in the population who are affected by these conditions, they would say they think that they have had rather good value for money in the service improvements that have been made. We have 138 new or modernised hospitals after many years of under-investment, and there are many areas in which we have put in new equipment. We have, for example, 1,200 new pieces of modern equipment purchased over the past five years to help consultants in cancer save more lives. These are some very specific numbers to show where the money has gone. Patients no longer have to wait hours to be seen in A&E departments. In fact, 98 per cent of patients are now seen within four hours. Ambulance services are reaching 75 per cent of potentially life-threatening emergencies within eight minutes. Amid all this, as I have said, waiting lists continue to fall.

Other major killer diseases have been tackled more effectively, and as I have said, premature deaths from heart disease, stroke and related diseases have continued to fall. If this was not already impressive enough, we have also worked to narrow health inequalities. I do not remember health inequalities being featured that strongly by the party opposite when it was in office. Health inequalities have been closing at a rate of more than 2.5 per cent in less than half a generation. In essence, that means that services are reaching everyone in society, including those who need the most but in the past might have struggled to gain adequate and appropriate access. Patients and carers now have many more ways to receive and provide advice and help without needing to use traditional NHS services. Notable examples of offering care and advice at a time and in a way that patients need are NHS walk-in centres and the NHS Direct telephone service and website. These are just two examples of new ways to help people get more and quicker access to services and advice.

A number of noble Lords have talked about efficiency. Anyone would think that there have been no improvements in efficiency under this Government. The average hospital stay in England decreased from 7.4 to 7.1 days last year, delayed discharges have fallen by more than 60 per cent. in the past four years, management costs are down from 5 per cent to 4 per cent in the past seven years, and cancelled operations continue to decline. It is not just me and other Ministers saying this—these developments and improvements have been recognised by others. The Healthcare Commission, in its report, The State of Healthcare, commented that,

"much should be celebrated . . . people are now able to gain access to many services more quickly and easily than in the past . . . long waits for hospital care have largely been eliminated".

That is an independent body looking at the evidence available.

However, I recognise the realities that a number of noble Lords have brought to the debate. I pay tribute to the noble Baroness, Lady Murphy, for the way in which she has contributed to the NHS, and I congratulate her, in her capacity as chairman of a strategic health authority, on bringing her budget in on balance, with good-quality services provided across east London. We recognise that some areas of the NHS still need to improve. In 2004–05, the NHS ended the financial year in deficit for the first time since The NHS Plan was published. As I have said, that needs to be put in historical perspective.

In the current perspective, however, the majority of NHS organisations are delivering good services, with service improvements, and living within their budget, as the noble Baroness, Lady Murphy, explained. The concerns are in a minority of organisations, and we are taking action with the under-performing organisations to ensure that financial balance in the NHS is achieved by the end of 2006–07. We will say more about some of these issues at a later stage. The Department of Health has put in place a comprehensive programme to work towards rectifying financial mismanagement problems in that minority of trusts experiencing difficulties.

I recognise the upset and frustration caused to the NHS by the errors in the 2006–07 tariff, under-payment by results, which a number of noble Lords have mentioned. As the Minister overseeing this area, I apologise unreservedly for the technical errors identified. We are trying to put those right. We will work with the NHS to test revisions as quickly as possible, to get a seriously good assurance that the revised tariff will be correct and will enable people within the NHS to get on with their financial planning. I must acknowledge that we should have done better in that area.

What of the future? Several noble Lords have mentioned our new White Paper, Our Health, Our Care, Our Say produced after a major public consultation. One of my best experiences as a health Minister was spending a Saturday with 1,000 people in Birmingham listening to what they had to say about their health priorities and what they wanted to see from the public services that they were funding. It is absolutely clear that the messages encapsulated in that White Paper were the messages that people were giving to us. This White Paper was not dreamt up in Richmond House; it responds to and reflects the views that people have put to us. They want to see more services closer to home, more services not in hospital, local government and the health service joining up work together more effectively, and more effort put into health promotion and prevention. They accept that they should have more responsibility in terms of self-care, but they want the public services to provide more support to help them do it, and more support for the people caring for them. We have a journey to travel, but it is one set by the people of this country, not just by the Government.

Several noble Lords have mentioned some of the changes introduced by the Government. I am grateful to the noble Earl, Lord Howe, for his recognition of the improved change of direction that we have been trying to introduce in relation to plurality of providers, more choice in the system and practice-based commissioning. I share his views that practice-based commissioning will make a real difference to the more personalised and appropriate services that patients will get. There is clinical buy-in. I acknowledge that we might have worked harder on selling to, persuading and working with general practitioners in this area. In the past year or so, however, we have put a lot of effort into working with the profession, and we have got considerable buy-in. This is a direction of travel that they want to see.

We have had some criticism for the introduction of independent sector treatment centres, but not, I was pleased to see, from the Benches opposite. These centres have already cut waits for diagnostic treatments and elective surgery for 250,000 people with a relatively small proportion of the NHS budget. They have caused parts of the NHS to reflect on their own clinical practices and the way that they provide care services to patients. That is a good innovation. We are still strongly committed to moving down the path of hospitals becoming foundation trusts. They have to have their finances in good order to do that, for the kinds of reasons that several noble Lords have mentioned. We are not taking our foot of the accelerator in that area, however, and I have recently sent another 20 or so candidates for foundation trust status to Monitor, and we have a programme to continue that in the coming months. I cannot respond to all the points made by noble Lords, but I promise to go through Hansard carefully and to write to all noble Lords on all the detailed points and concerns that they expressed. I hope to be able to say yes to my noble friend Lord Stone about speaking at his conference.

I must respond to and correct one issue, which relates to the concerns expressed by the noble Baroness, Lady Cumberlege, about computerised applications for doctors under the new system of modernising medical careers. I freely acknowledge that there is an online application process. It is, however, marked by experienced doctors from the postgraduate deaneries. Computers have no say in that process. It is a fair, open and transparent process and provides a single gateway for all applicants and helps practitioners match applicants to vacancies. I have already written to The Times, which published today a letter rebutting the erroneous set of statements previously published.

In conclusion, our strategy of investment and reform was always going to have some bumpy periods because of the scale of our ambition to improve the health and social care system for all our fellow citizens. My noble friends have rightly paid tribute to the considerable advances that we have made in the NHS. Those advances are also a reflection of the huge investment of effort by NHS staff of all grades who have committed themselves to improving and turning round the NHS. We have to keep our nerve. I accept that things in some cases could have been done better, but that could be said of all governments. All governments could do things better with hindsight—hindsight is a wonderful thing—and I freely acknowledge that we have made some mistakes, but the direction of travel is right. We have hugely improved the services for people living in this country.

I finish by paying tribute to all that the NHS staff themselves have done—if I may put it this way—to rescue the NHS from the years of neglect under our predecessors. Working in partnership with doctors, nurses, allied health professionals, porters, cleaners, catering staff, managers and non-executives, we will come through this difficult patch. We will ensure that the NHS continues to improve and meets what I recognise are the understandable rising expectations of our fellow citizens. At the core of our debate are the needs of patients and carers, and it is on those that we all need to focus and make sure that we can make their lives better.