§ The Secretary of State for Health (Mr. Frank Dobson)
With permission, Madam Speaker, I wish to make a statement. The Government's top priorities are to renew and modernise our country's health and education systems. On Tuesday, my right hon. Friend the Chancellor of the Exchequer was able to announce that, as a result of our comprehensive spending review, an extra £21 billion will be invested in the national health service in the United Kingdom over the next three years—approaching £18 billion in England. This is an average annual real-terms increase of 4.7 per cent. over the three years—starting off with 5.7 per cent. next year. It will kick start the Government's 10-year programme of modernisation for our national health service.
This is the biggest cash increase ever announced for the NHS. The step change in funding will be matched by the biggest programme of renewal and modernisation since the NHS was founded—investment for reform. £21 billion is a large sum of money. It was welcomed by the representatives of all the people working in the NHS and described by the National Health Service Federation as beyond their wildest dreams. However, when set against the rundown state of the NHS which we inherited, when set against the improvements which the staff and the public are seeking, and when set against the scale of our ambitions for the service, even £21 billion is a settlement which will have to be tightly managed and properly targeted.
Not all the problems that we inherited in the NHS will be solved over the next three years. They are too deeply entrenched for that. Not all the improvements that we seek can be delivered in that time. But what both staff and the public will see is demonstrable year-on-year improvements in all parts of the health and social care systems.
Staff and patients alike want to see a modern and dependable service. A modern health service requires high and stable levels of funding. In all its long history, the NHS has never before had a three-year settlement. The NHS has never been able to plan beyond the short term. Modern organisations have to plan for the longer term. The NHS can now do that for the very first time
A modern health service requires enough staff, well trained and highly motivated. With the extra money that we are making available, the NHS will be able to take on more doctors and more nurses—up to 7,000 more doctors and 15,000 more nurses over the next three years. Earmarked funds will be provided to allow staff to update their skills to keep up with rapidly changing technology. I can tell the House today that, over the next three years, there will be an extra 6,000 nurse training places, and I will shortly be announcing a large increase in the number of places in medical schools. With those extra staff, NHS hospitals will treat an extra 3 million patients.
Expanding staff numbers, in particular to deal with some of the shortages that we know exist, depends on pay rises being fair and affordable: fair, to allow us to recruit and retain motivated staff; affordable, to allow us to make the modernisations that patients demand. Fair pay and modernisation must go hand in hand, and that is why, for the first time, we are asking the pay review bodies formally to take into account the service improvements 572 that we want to achieve, the resources available to the NHS and the Government's inflation target, as well as recruitment and retention.
The three-year settlement allows the NHS to take a longer-term view. Now that funds are guaranteed for three years, there should, for example, be no more systematic use of short-term contracts of employment for nurses and other staff. That will provide security that they do not have at present.
A modern health service requires modern buildings and modern equipment. Over recent years, the NHS has been starved of capital. We are putting that right. That is why, as part of the modernisation programme, £8 billion will be invested in new hospitals, clinics and GP premises. Thirty new hospitals are already planned, and work is already under way at eight: Dartford and Gravesham, Norfolk and Norwich, Carlisle, High Wycombe, Durham, Sheffield, Amersham and Greenwich. There will be more to come, and new and better buildings will not be confined to the places that are getting new hospitals. We will be increasing public sector capital by 50 per cent., and hospitals in every part of the country will benefit. Hundreds of wards, accident and emergency departments and operating theatres will be refurbished, and, every year, outdated equipment will be replaced with the newest and best that medical science can offer.
We are investing in primary care. Over the next three years, more than 1,000 GP surgeries will be improved or rebuilt. A modern health service requires earmarked cash to make change happen. I can announce today that the £18 billion settlement for England includes a £5 billion-plus modernisation fund. That money will be strictly targeted on helping NHS staff to transform the NHS into the kind of service that they and we want to see—a service that is fast and convenient, has uniformly high standards and is moulded to the needs of patients.
The modernisation fund will fund an information technology revolution in the NHS. It will go towards making sure that we meet the reductions in waiting lists to which we are committed. We will also use money from the modernisation fund to make a start this coming year on introducing booked admissions, so that when patients are told by their GPs that they need to attend an out-patient department, they will be able, there and then, to book an appointment that suits them. Similarly, if people have to have surgery as a day patient or an in-patient, they will be able to book an admission date that suits their needs, and their family and work requirements.
Besides contributing to the refurbishment of hospitals and the building of new GP premises, the fund will help to buy new equipment, support the promotion of good health, pay for better training of NHS staff and provide modern and effective mental health services. The modernisation fund will be allocated to finance well worked-out plans and proven mechanisms for improving services. It is investment for reform.
A modern health service requires modern ways of working. By getting rid of the wasteful and divisive competitive internal market, we are taking money out of the Tory-created bureaucracy and putting it into patient care. Primary care groups involving doctors, nurses and social services will replace the maze of commissioning and fundholding organisations. NHS trusts' managements will be amalgamated, and competition between hospitals is being ended; they are working together again, and they will continue to do so.
573 The NHS is, proudly, already the most cost-effective health care system in the world, but there are still unacceptable variations in performance, and management effort will be targeted on hospitals where costs are above the national average. A new performance framework will help to measure progress. Our value-for-money improvements should release a further £1 billion for patient care. There will be a tough drive for genuine efficiency. That means more money for patients and staff, and better value for taxpayers.
A modern health service requires a new relationship with social services. We have made a start on breaking down the Berlin wall between the NHS and social services. To back that up, over the next three years, we are providing an extra £3 billion for social services so that they can match, complement and augment what the NHS is doing. That is an increase of 3.1 per cent. in real terms, year on year on year. For the first time, they will be able to produce joint, local, long-term plans with the national health service and then implement them.
For the first time, we will be setting tough efficiency targets for all social services authorities to help them deliver the goods for vulnerable people. It will mean better help for the elderly, and better and more help for carers. There will be new measures to allow tens of thousands of old people to live an independent life, where, at present, they end up trapped in nursing homes or hospitals. It will mean more help for people with mental health problems to match the extra NHS commitment to mental health.
Arrangements for looking after children in care have far too frequently been deplorable, with children being molested and with low levels of school attendance and educational attainment. Many of them have been turned out of care to fend for themselves when they are little more than children. We are determined to give them a new deal, and the extra social services money will provide the funds necessary to improve the quality of care received by children living away from home—and not before time.
All that effort and all that investment is intended to deal properly with people when they need treatment and care. But the Government are not satisfied with a health policy just for treating the sick. We want to stop people getting ill in the first place and stop people dying prematurely. We want to tackle the growing inequalities in health. That is a job for the whole Government, not just the Department of Health.
The comprehensive spending review settlement is not just a good settlement for our health service; it is a good settlement for our people's health. We have provided £540 million for the Sure Start children's fund, almost £4 billion to invest in decent housing and improved insulation, £3 billion for deprived communities and £1.7 billion for transport, particularly public transport. That is on top of our earlier commitment to the £3.5 billion new deal for jobs and our introduction of a national minimum wage. All that amounts to the biggest health crusade the country has seen since the NHS was born 50 years ago—a modern, Government-wide crusade.
The NHS was founded on the simple principle that care should be provided on the basis of need. That principle has served the NHS well for 50 years. While we were considering the comprehensive spending review we 574 were urged by all sorts of people to abandon that principle. We were urged to do so by some Conservative Members, by the Social Market Foundation, by the Adam Smith Institute, by many of our newspapers and by various pointy-headed professors. They wanted us to charge people for going to the doctor. They wanted us to charge people for going to see their GP, for attending out-patient departments and for going into hospital. We have looked at all that very carefully. We have looked at all the pros and cons, and we have spent the best part of a year doing it. We utterly reject those ideas. We have rejected them because they would not work and they would harm the worst off. Charges would be expensive to collect and would glean little overall revenue. Most important, charges would deny treatment to those who need it most. I can announce today that there will be no new NHS charges in this Parliament.
We have not stopped there. From next April, the NHS will provide free eye tests for pensioners. That will be good for their purses and pockets, good for their sight, and good for their general health.
This is an historic financial settlement. It will enable the hard-working and dedicated staff of the national health service and social services to provide the treatment and care that people need, and to provide it to a higher standard than ever in every part of the country. It will modernise and renew the national health service. The extra money will be matched by enormous changes and improvements.
Over the past few weeks, we have been celebrating the 50th anniversary of the national health service. That was right and proper, but now we must do as the founders of the NHS did—we must look forward, find the resources, and make the changes that are necessary to relaunch the national health service so that it serves our country well for the next 50 years. Nothing less will do, and that is what the Government are doing.
§ Miss Ann Widdecombe (Maidstone and The Weald)
May I start by regretting that the Secretary of State for Health did not manage on this occasion to observe the usual courtesies and conventions and that I did not have sight of his statement until 3.17 pm? I am returning his discourtesy with a considerable courtesy of my own. Even at this moment, the questions that I am about to ask are being brought to him so that he will have them in front of him and I shall not have to ask him to remember all that I have asked. Therefore, he will be able to address himself to every question.
The Government figures on Tuesday claimed that £21 billion of extra money for our health service was being made available, of which some £18 billion was for England alone. Closer inspection of the make-up of those figures suggests an exercise in accountancy so creative that if it were in any other context one would be sorely tempted to call in the Yard. I have some brief questions for the Secretary of State, and I would appreciate his answering fully and frankly. The questions are in front of him now.
First, can the right hon. Gentleman confirm that the difference in overall UK health spending between 1998–99 and 2002 is £10.5 billion, of which £8.8 billion is for England? Does he accept that independent figures that have been produced by the House of Commons Library show that the extra money from the 575 comprehensive spending review over the Conservative real-growth trend of 3.1 per cent. is just over £2 billion and that, although it is welcome, it is a long way from Tuesday's hype and hyperbole? Does he accept that there is an enormous difference between what can be purchased for £2 billion extra and what can be purchased for £18 billion extra?
I am happy to approach the figures either on the double-counting, triple-counting basis of the right hon. Gentleman's £21 billion or on the Opposition's straight increase basis, provided that the same method is used to calculate both his extra spending and our extra spending. Will the right hon. Gentleman confirm that, no matter which way he does it—on his basis or on mine—it results in a £2 billion difference for England, not an £18 billion difference? I shall now move to the main body of his statement. [Interruption.]
If the Secretary of State would look me in the eyes, we might believe that he was as happy as he is trying to suggest. Will he confirm that the independence has now been taken out of the independent pay review body and that its recommendations are now subverted to Treasury consideration? Is not that a betrayal of the very principle of such review bodies? What is the right hon. Gentleman's response to the comment by the British Medical Association that it objects to any unilateral attempt to undermine the even-handedness of the pay review body? Will he undertake to honour the recommendations of any such body in future?
Will the Secretary of State confirm that the announcement is not of the largest real-terms three-year increase in the history of our health service, as the Chancellor so glibly asserted on Tuesday? All he has to do is to read the editorial in The Independent today. If he does, he will find that even that paper agrees. It is below the 5.6 per cent. that we spent between 1990 and 1993. I ask again: will the right hon. Gentleman confirm that this increase is below the 5.6 per cent. increase that we spent in the first three years of this decade? Does he accept Peter Riddell's comment that the Chancellor's public spending statements are like the words of Lewis Carroll: nothing is quite as it seems and the cat's smile vanishes on closer inspection?
Certain specific items of expenditure will have to be taken from the extra money that the right hon. Gentleman has announced. Will he tell me what each one will cost? How much has he made available or set aside for the millennium bug—is he aware that his own Audit Commission said that the cost could be as high as £850 million? How much is he setting aside for the additional costs of the minimum wage to the health service? How much is he keeping for the abolition of compulsory competitive tendering? How much is he allowing for the abolition of tax relief on private medical insurance for the over-60s?
Does the right hon. Gentleman agree that, by the time that he has set against all his figures the Government's inflation targets—I will be kind and assume that they will be realised—the rate of increases that we managed over our term of office, the costs of the minimum wage, the costs of the millennium bug, the costs of abolishing private medical insurance and compulsory competitive tendering, and the costs of administering each primary care group, his extra £2 billion, welcome though it is, 576 is worth little more than a few hundred million? Finally, is he aware—Will he look at me at this point? [Interruption.] He will not look at me, and I suspect that he will not face the employees of the NHS, among whom initial high hopes on Tuesday are now turning to disbelieving anger.
§ Mr. Dobson
At Department of Health Question Time as recently as last week, the right hon. Lady said that an increase of £9 billion would be the minimum that would be required to meet the Tory level of spending for the NHS. We have increased the sum by £18 billion, double what she asked for—and, for that matter, double what the Liberal Democrats were asking for. If they do not understand the figures, let me give some simple arithmetic, rounded for purposes of argument. Next year, there will be an extra £3 billion. The year after that, there will be an extra £6 billion. The year after that, there will be an extra £9 billion. Even in the Tory arithmetic book, 3 plus 6 plus 9 amounts to 18.
I know that the right hon. Lady claims that the £21 billion is £2.1 billion, and I know that she is not yet old enough for free eye tests, but the figures show that it is £21 billion; there is not a decimal point between the 2 and the 1.
As everyone knows, the pay review bodies have always considered all the other aspects that we have referred to, but those aspects have never been on the face of their terms of reference. All we have done is make it explicit—we think that that is right and proper—rather than trying to do it furtively, as previous Governments have done.
It is bare-faced cheek of the highest order for any Tory to ask what provision we are making for the problems of the millennium bug. When we got in, the Tories had made no provision, although, even for a collection of witless loons like them, the fact that the year 2000 was only three years ahead must have been fairly obvious.
On the national minimum wage, I can confirm that we have made provision for £21 million towards meeting its cost. Even £21 million is too much, and it is a national disgrace that, after 18 years of Tory rule, people working in the health service are getting paid less than the minimum wage.
The costs of primary care groups will cover every general practitioner in the country, and their running costs will equal those of the fundholders who used to represent half the GPs; so we have doubled the efficiency of the system in one fell swoop.
To return to my first point, whatever the right hon. Member for Maidstone and The Weald (Miss Widdecombe) may do, whatever questions she may have asked the House of Commons Library to answer—questions and, therefore, answers for which the Library staff are not responsible—and whatever answers she may have been given, people representing those who work in the health service have told me personally or have said publicly that the settlement is beyond their wildest dreams. It is a huge sum of money, which will have to be spent carefully, so that we get full value for money.
The right hon. Lady normally prides herself, or so she claims, on being straightforward. Last week, she said that if we found £9 billion she would thank us for it, but she cannot even thank us for £18 billion.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
The Secretary of State knows that cash for 577 health is welcome. The Liberal Democrats and others have been urging the Government to take that step since before they were elected and now they have acceded to our wishes, so we are grateful. Without getting into a debate about the billions, can the right hon. Gentleman confirm that 4.7 per cent. for the next three years, which is his figure, means 3.7 per cent. over the five years of this Parliament? Given that everyone accepted that 3 per cent. was needed in the national health service to keep up with inflation, although the additional money is additional and welcome spending money, it is hardly the lottery jackpot.
On staff, can the Secretary of State tell us whether his announcement and the figures today mean that the 8,000 nursing and 2,500 doctor vacancies in the health service will all be filled by the end of the three years? How many additional staff will there be in the service in three years' time, over and above those who are there today? When the pay review body recommends increases in future, with its tighter remit, will those always be implemented immediately and in full rather than staged, which is what the Secretary of State and his colleagues have done in the past year?
Really, it should not be a cause for celebration that a Labour Government tell the House that there will be no more charges. Surely the Secretary of State must answer why a policy that prescription charges will increase for the next three years, as they have done this year, is consistent—that is the Government's policy—when two years ago the Labour party said that increasing such charges was a tax on the sick.
On waiting lists and waiting times—the right hon. Gentleman's own target—at the general election, £100 million was to produce 100,000 off waiting lists as an early pledge. Now that we have £21 billion, will more people come off waiting lists or will it still be only one in 13 by the end of this Parliament? When will everyone know that six months will be the maximum time that they have to wait? If we are trying to keep pressure off the health service, why continue to cap social services budgets when such services can often provide cheaper care?
Does the money that the Secretary of State announced today mean that a hospital such as the Freeman cancer centre in Newcastle can know that, at the end of the three years, it will have curtains round the beds, a shower as well as a 30-year-old bath and separate toilets for men and women?
In my constituency, will the mentally ill know that support services will be available at the weekends and at night, as well as during the day? Will we have a 24-hour-a-day, seven-days-a-week health service that is equal and available to all, which is what the people of Britain expect a Government to provide?
§ Mr. Dobson
For a start, it is worth saying that the national health service is a 24-hour-a-day service. Countless numbers of our fellow citizens deliver that service 24 hours a day, and we should thank them for it, rather than suggest that they are not there some of the time. I say to the representative of the Liberal party what I said to the representative of the Tory party. As recently as last week, the Liberals asked us to guarantee to deliver £9 billion extra. When we deliver £18 billion extra, they have the gall to start whingeing and moaning as usual—which is, I suppose, what qualifies them as Liberals.
578 Yes, we want to recruit up to 7,000 extra doctors and 15,000 extra nurses, but we obviously cannot guarantee that every shortage in every part of the country will be wiped out over the three years, as sudden acute problems arise in some places and not in others. All that I believe is that we shall be able to go a long way towards resolving those problems, and we shall recruit additional staff so that hard-working doctors, nurses, midwives and other staff are not run off their feet. I really hope that we shall be able to achieve a pay settlement that does not involve staging. That is all that I can say at the moment, but I hope that we can create a system that is fair to the staff and affordable to the country.
The hon. Gentleman referred to the social services budget. He must have prepared his question before I spoke, as I explained that there would be a £3 billion increase in the amount available to social services, so that they can match the extra money and effort from the NHS to provide an adequate mental health service for people in his area and in every other area.
We are determined to bring down waiting lists. They are coming down, and will continue to come down. Waiting times will also come down; by reducing waiting lists on the scale that we are, we shall ensure that waiting times come down, too.
We hear yet again the Liberal obsession with the extra 1p on income tax, which is spent on practically everything that one can think of. The Liberals must be the only party in history whose slogan is, "I want to spend a penny."
§ Mr. David Hinchliffe (Wakefield)
May I be the first to welcome warmly my right hon. Friend's announcement, which I am sure the population as a whole will recognise as the best possible way in which to celebrate 50 years of the national health service? I have two practical questions. First, does he share my experience that a common thread of the representations and complaints that we receive on the NHS relates to immense pressures at ward level on hard-pressed doctors and nurses? What, in practical terms, will the global amount of money mean at ward level in constituencies such as mine?
Secondly, may I warmly welcome the announcement on personal social services, which I believe has been a forgotten area of the caring professions for many years? Will my right hon. Friend give practical examples of the way in which the money will impact on personal social services and, indirectly, on the NHS locally?
§ Mr. Dobson
I thank my hon. and hard-working Friend for welcoming my statement and that of my right hon. Friend the Chancellor on Tuesday. I agree that, in many ways, the worst aspect of the national health service—it is felt by many patients and people who visit them in hospital—is the fact that the staff are overstretched and run off their feet, and we want to reduce the impact of that by spending money on modernising wards.
That will help in some cases, because the layout of some wards—and the fact that they are clapped-out, ruinous and awful—means that the work is harder than it ought to be. We intend to recruit more nurses and doctors, which should relieve the pressure. We intend to try to extend the role of nurses, so that they can make a bigger professional contribution, which will also bring some relief.
579 We hope that NHS Direct, the nurse-led 24-hour helpline, will employ nurses who have had to leave nursing, for instance because of a back injury acquired at work, to provide advice over the telephone. That will be a good way of making use of their nursing skills, and will reduce pressure.
We must try to stop people having to come into hospital when they do not want to and it is unnecessary. People in the health service, with our encouragement, have made substantial steps in that direction, especially last winter. I give again the example of Halton general hospital in Cheshire, where, when old folks who were admitted with a bad chest were discharged, a respiratory nurse team picked them up and looked after them at home. That worked so successfully that the GPs in the area started referring old folks who were having a bad chest at home to the respiratory team, so that they could be treated at home and did not have to go into hospital at all. A hospital is a dangerous place, and is the last place where frail old people should be, if it can possibly be avoided.
All those changes are intended to relieve the pressure on the hard-working people in the health service. It cannot be done overnight, but we have to recognise that those people are the health service.
§ Mrs. Marion Roe (Broxbourne)
I welcome any additional funding for the NHS, although it is not as much in real terms as the Secretary of State would have us believe, but how does he intend to deal with the serious GP shortages that currently exist, with approximately 1,000 vacancies, especially as evidence published in the past two weeks shows that GP list sizes, so effectively brought down by the previous Conservative Government, are rising again?
§ Mr. Dobson
It is a bit difficult for a Government who have been in power for only 14 months to take responsibility for the supply of doctors, when a doctor only now leaving medical school and beginning to do something useful probably started about 10 years ago—or did not start, which is one of our problems. We are dealing with the shortages, and, for the first time in ages, there has been a rise in the number of doctors becoming GP trainees, which is a step in the right direction.
Using the facilities made available by the previous Government, we are encouraging the appointment of salaried GPs in some of the areas where the shortages are worst, and we intend to continue, with other schemes that we are working out with the profession, to try to relieve the problem, but if we are to succeed, and to tackle health inequalities at the same time, our principal target must be to get better GP practice in those inner-city and other rundown areas where people are currently not getting a fair share of the resources.
§ Mr. Gordon Prentice (Pendle)
I warmly welcome the statement and the extra 7,000 doctors and 15,000 nurses, but north-east Lancashire has been described as a dental desert, and, only this week, East Lancashire health authority is advertising in Scandinavia for additional dentists. Does my right hon. Friend have indicative figures for the number of additional dentists that we could expect to have in post at the end of this three-year period?
§ Mr. Dobson
The straightforward answer is no, I do not have those figures at the minute, but I can tell my 580 hon. Friend that, as a result of the initiatives that we have taken in our short period in office, an extra 250,000 people have been able to become NHS dentistry patients.
§ Mr. Nicholas Winterton (Macclesfield)
May I tell the Secretary of State that, only yesterday, as a result of an unfortunately heavy fall in Trafalgar square, I experienced the expertise and care of not only the London ambulance service, but the junior doctors, nurses and staff at St. Thomas's hospital? It was brilliant. I have no complaint. It was first class, but they were overstretched and under stress. Does the Secretary of State's announcement, particularly in respect of additional doctors and nurses, mean that that sort of stress and overstretch in an accident and emergency department at a hospital such as St. Thomas's will improve and that those who genuinely need more money for the wonderful work they do, particularly junior doctors and nurses, will get what they deserve—bigger remuneration?
§ Mr. Dobson
The hon. Gentleman rightly pays tribute to the people who looked after him, and I am sure that he is right in his observation that they are overstretched and under stress. With the proposals that I have outlined today I want to reduce that stress. Obviously, it will take a considerable time to bring that about in every part of the country, but that is what we want to do. I also want to see people who work in the national health service getting fair pay for the huge contribution that they make to the welfare of our people. I hope that we can manage that. We shall work hard to achieve, it. Certainly, the extra money will assist us in that.
§ Audrey Wise (Preston)
May I congratulate my right hon. Friend on the success of his efforts to improve the national health service? In particular, may I welcome his intention to improve services for children? I was pleased that he mentioned children being looked after by local authorities. Although he will not yet have had time to study the report on this subject issued today by the Select Committee on Health, will he ensure that he and his Department give it careful attention, because our recommendations will undoubtedly help him achieve his stated objectives? Finally, will he make sure that he never forgets the need to improve choice and continuity of carer for women in pregnancy and childbirth?
§ Mr. Dobson
Dealing with my hon. Friend's questions in reverse order, I shall do my very best not to forget what she has said about choice and continuity of carer for women in pregnancy and childbirth. In many parts of the country children's services have been a national disgrace. Children who, in effect, have had the state as their parent—
§ Mr. Dobson
It is all very well shouting out a place name because it happens to be Labour controlled at the moment, but there are plenty of examples from all round the country. As all hon. Members know, if they are not just making stupid party-political points, there has been a group of organised child molesters getting appointments in all sorts of children's homes, some of which are run by 581 charities, or Labour authorities, Tory authorities and Liberal authorities. It is a disgrace that it has not been dealt with. We are trying to deal with it now.
Before I was interrupted, I was pointing out that if the children who, in effect, have had the state as their parent had been looked after by ordinary parents, those parents would have been prosecuted and gaoled for neglect. That shows how some children have been treated in children's homes; it must end. The Utting report made a large number of recommendations. I have been chairing a working group which has been going through them. We shall find the money to implement virtually all of them, and I hope to make announcements on that shortly. We shall certainly bear in mind the additional scrutiny of the Select Committee on Health.
It is intolerable that in many parts of the country, on reaching the age of 16 some children are just turned out by the local authority to fend for themselves. No hon. Members would have wanted that to happen to them or to their children or, possibly, in view of the age of some of us, grandchildren. That would be an intolerable concept. But that has been going on in our name as recently as last month, and it cannot go on any longer.
§ Mr. John Wilkinson (Ruislip-Northwood)
It would be churlish not to congratulate the Secretary of State on securing from the Chancellor a financial settlement which goes at least a little of the way to matching his grandiloquent rhetoric, but may I bring him from the euphoria of the general to the specifics, because it is on the specifics that he will be judged by our electors? Will he ensure, as evidence of his good faith, that the Mount Vernon hospital at Northwood, the largest cancer hospital on a single site in the south of England, will not see its supporting burns, plastics and oral surgery, general medicine and general surgery removed, because, if they are, that cancer centre, with its outstanding research facilities, will go into a decline from which it may not be possible to recover?
§ Mr. Dobson
I thank the hon. Gentleman for his welcome for what I have said. Like most people, I respond rather better to encouragement than criticism. I shall bear in mind the points that he makes about the Mount Vernon hospital, because the last thing that we want to see is good and effective treatment and care being taken away from anywhere.
§ Ann Keen (Brentford and Isleworth)
As a nurse for more than 20 years, I warmly congratulate my right hon. Friend on his amazing achievement in giving back to the people our health service and the security that it entails. All the professions respect him so much because he always demonstrates such a wide understanding of their work. But, looking at nurse recruitment, particularly in my constituency of Brentford and Isleworth in west London, does he agree that the problems facing people who want to recruit or retain student nurses, which we must address seriously, include accommodation and the cost of accommodation? The previous Government sold off nurses' homes, and that was encouraged. We now need to revisit the question of accommodation for our student nurses.
§ Mr. Dobson
I thank my hon. Friend for her kind welcome. Nurse recruitment is a major issue. Pay is one 582 consideration, and accommodation is another. This is one of those circumstances where it is not easy to turn back the clock. The previous Government having sold off so many nurses' homes, it takes quite a bit of time to find alternative accommodation, if that is the right way to deal with the problem.
§ Mr. Dobson
In some areas it might be the right way, but in some areas it may not. The problem is that the previous Government pursued that policy in those areas where it might have been a sensible policy and in those areas where it was not. We are trying to address matters, such as accommodation, which either make nursing unattractive to someone who might be thinking of becoming a nurse or increasingly unattractive to people who are already nurses.
We are trying to establish more family-friendly employment policies so that nurses, whether men or women, with family responsibilities, can work the hours of the day, the days of the week, or, in some cases, because of school holidays, the weeks of the year that suit those responsibilities. Some hospitals manage to do that, and I do not understand why others cannot. They are, shall I say, being encouraged to follow the good examples.
We are also putting a great deal of effort into something else that is putting people off working in the health service: we are taking seriously assaults on and abuse of staff. We have taken steps within the health service to try to reduce that. My right hon. Friends the Lord Chancellor and the Home Secretary are also doing their bit through the judicial system and the police to ensure that if people commit offences, they are caught and prosecuted and, if they are successfully prosecuted, they get a rattling bad sentence. They should. It is quite wrong that the people working for us, trying to look after us, our friends and our neighbours, should be beaten up by anybody. There is no excuse for that, and we shall accept no excuse for it.
§ Miss Julie Kirkbride (Bromsgrove)
The Secretary of State has made much of the Government's spending plans, and I want to encourage him rather than criticise him, by saying that I broadly go along with them. However, the people of Worcestershire have three general hospitals, but face the axing of one of them. Kidderminster general hospital, which serves my constituents and those of the hon. Member for Wyre Forest (Mr. Lock), is excellent and efficient, and it has won a chartermark, but its proposed closure is on the Secretary of State's desk. If his spending plans are accurate, can he promise my constituents and the people of Worcestershire that he will put a stop to that closure?
§ Mr. Dobson
I believe that we do not yet have the proposals on our desks, but I will use the excuse that they might be there, which means that it would be improper for me to make any promise one way or the other because it could be challenged in the courts. I shall carefully consider all the evidence. Unlike some of our predecessors, we are not supine when it comes to hospital closures, and we are not approving some of them.
§ Dr. Howard Stoate (Dartford)
May I tell my right hon. Friend that his statement will be warmly welcomed by general practitioners and primary care nurses 583 throughout the country, and particularly in Dartford? How will the welcome modernisation fund be channelled into improving GP premises, some of which are sorely in need of modernisation?
§ Mr. Dobson
The funds will be channelled into areas where people say they are needed. We want to be positive, and to improve appalling GP premises in areas such as the constituency of my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore). We have set the test of whether we would go to a GP who had premises like some of those in that constituency. The answer is no, and we should not tolerate the long-term existence of places that we would not use ourselves.
§ Mr. Robert Walter (North Dorset)
Health care is expensive, and costs are ever expanding as we live longer and technology advances. I read some research this morning that suggests that costs are growing at between two and two and a half times the rate of inflation in the United States. The assumptions underlying the Secretary of State's figures are based on a Treasury GDP deflator of 2.5 per cent., which is very optimistic and higher than this year's 2.9 per cent. Can the Secretary of State tell us what assumptions he has made for increases in staff costs over the next three to five years, and which NHS costs are likely to rise well ahead of the rate of inflation?
§ Mr. Dobson
The hon. Gentleman should remember that his party asserts that a 3 per cent. year on year real-terms increase is satisfactory. We are proposing 4.7 per cent.
§ Mr. Dobson
It is 4.7 per cent. over the next three years, and 3.7 per cent. over five years. If we take a five-year average, the Tory figure falls to 3 per cent., not 3.1 per cent. I do not want to get into that kind of nonsense. The increase is 4.7 per cent. over the three years in question, which is a massive and steady improvement on anything that happened under the Tories. We are ensuring that the money is directed into providing necessary services.
We should not challenge assumptions on UK health costs by comparing them with figures from the United States, which spends twice as much of its national wealth on health, but where neither women nor men live as long as British women and men.
§ Mr. Richard Burden (Birmingham, Northfield)
Judging by the questions posed by the right hon. Member for Maidstone and The Weald (Miss Widdecombe), does my right hon. Friend agree that, in comparison, pointy-headed professors might have a reasonable grasp of what is going on in the health service?
In respect of primary care, today's announcement will be widely welcomed across the country, because we have a great deal to do to put the legacy right. Is my right hon. Friend aware that, in Birmingham, between 35 and 40 per cent. of GPs in the most deprived areas will be retiring in the next 10 years? We desperately need not only to increase the number of GPs but to make the necessary 584 investment in primary care to ensure both that people have the quality of health care that they deserve, and that accident and emergency departments are able to provide an A and E service, instead of becoming, as happens all too often, a substitute for inadequate primary care.
§ Mr. Dobson
I certainly accept my hon. Friend's points. Clearly, we have to use all human and other resources possible both to try to improve the state of primary care in the most deprived parts of the country, and to put ourselves in readiness for the retirement of some GPs.
That is certainly one reason, albeit not the only one, why extending the role of nurses and district nurses to being nurse practitioners and other, similar measures will clearly make a contribution. We have a system in which large numbers of highly trained and skilled people are not permitted, under our present arrangements, to make full use of their skills and training to the advantage of the rest of us. That certainly applies to nurses and midwives, as well as to local pharmacists. Pharmacists do a four-year course, but frequently do little more than hand over pills in the local pharmacy. We want them to play a bigger role in primary care, which would be another way of getting more out of them, making their jobs more satisfying and, at the same time, providing a better all-round service.
My hon. Friend referred to the right hon. Member for Maidstone and The Weald and I should come back to her.
§ Mr. Dobson
I am going to apologise. I always do my level best to comply with the courtesies of the House in respect of informing the Opposition about things, so I am sorry that my office did not manage to get the statement to the right hon. Lady. I certainly cleared it before 3 o'clock, and I assumed that she would get it then.
§ Rev. Martin Smyth (Belfast, South)
I welcome the statement, especially the fact that we are looking three years ahead. Bearing in mind the fact that the Secretary of State, like myself and others, grew up with the old saying that half a loaf is better than no bread, may I nevertheless press the issue of the recruitment of staff? If we had new medical students going in this September or October, before they were fully qualified, that would be almost the 10 years up. At the same time, may I ask about the recruitment of nurses? Do we intend to advertise to bring nurses from overseas? What about therapists? We are putting cancer treatment high on our list, but there is a shortage of radiotherapists and radiographers.
§ Mr. Dobson
I thank the hon. Gentleman for his welcome for my statement. Most of what I have been saying applies to Northern Ireland, and my colleagues will be trying to apply it there. He raises the issue of the difficulty in recruiting staff and it is no good my pretending that there is no difficulty in recruiting staff, be they doctors, nursing staff or, as he says, therapists, many of whom are in extremely short supply. It is difficult, because one cannot turn on a tap and have qualified therapists come out.
However, there is a substantial number of people who used to work in the national health service, but who left for one reason or another. There are about 140,000 nurses 585 and a substantial number of doctors. Dr. Ian Bogle, who has just become chairman of the British Medical Association and whom I congratulate on his election, was saying this morning that he thought that, given the right circumstances, we would be able to recruit doctors who had left the service back into it. I believe that that would apply also to nurses and to the professions allied to medicine. However, it will be a long, difficult and laborious task, which will have to be done locally in response to local circumstances.
§ Shona McIsaac (Cleethorpes)
Will my right hon. Friend send his congratulations to the staff at Grimsby hospital who have worked phenomenally hard to reduce its waiting lists? They are on target to reduce them by about 1,400 by next year. Before the general election, that hospital was in danger of being downgraded because the health authority was severely underfunded, thanks to the previous Government. I know that Grimsby hospital and all the residents of Grimsby and Cleethorpes will be delighted with my right hon. Friend's announcement today.
§ Mr. Dobson
I thank my hon. Friend for her welcome for our actions. I certainly congratulate all the staff of Grimsby hospital on their work. I hope that they will receive their fair and proper share of the extra funds and that they will continue to be as efficient and productive as they are today.