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Public Accountability (NHS)
7. Mr. Hinchliffe: What steps he is taking to improve public accountability in the NHS. [29321]
Mr. Dobson: As part of our efforts to improve accountability in the NHS, I have required all health boards to meet in public, I have opened up the appointments process, I am placing a duty to co-operate on all parts of the NHS and I require every health authority to prepare a health-improvement programme for its area, in consultation with all interested local organisations.
Mr. Hinchliffe: Will my right hon. Friend take steps to end the practice whereby local health authorities blatantly mislead the public during consultation on closures or changes in the use of health facilities? Will he consider as an example what has happened in Wakefield? A few years ago, Manygates maternity hospital, where I and my children were born, was closed and the health authority gave a clear commitment to build purpose-built maternity provision at Pinderfields general hospital. Not only has that promise never been fulfilled, but there is now a proposal to remove maternity facilities completely from Wakefield. As a Yorkshireman, does he agree that it is inconceivable that people will no longer have the chance to be born in the capital of the West Riding of Yorkshire--my constituency of Wakefield?
Mr. Dobson: I am not sure that I should refer to anything being inconceivable in relation to maternity services, even in Yorkshire. Certainly, one problem facing the national health service when it is trying to re-establish its reputation with local people is that there have been examples of clear promises being made--that if people went along with one closure there would be an opening to compensate, or something of that sort--which were not delivered.
We are determined to ensure, first, that the process of consultation is not merely a period of time but a genuine consultation and, secondly, that, if local promises are made, local promises are kept. The Minister of State, my hon. Friend the Member for Darlington (Mr. Milburn), and I had to make very sure in some funding allocations that we had a hand in that certain promises were kept. If the funds had been allocated according to the propositions that came to us, the NHS would have been going back on promises, but we stopped that.
Mr. Maples:
One measure of accountability is the publication of waiting lists. Why does the Secretary of State think those are rising?
Mr. Dobson:
At the danger of sounding like the right hon. Member for South-West Surrey (Mrs. Bottomley), which I should hate to do--she has now left the Chamber having asked her question--in the last quarter for which figures were produced, the people working in the health service dealt with more emergency cases than ever before in the history of the NHS. They also dealt with more waiting list cases than in any previous third quarter of the financial year. The only trouble is that the number of people joining the list grew faster than the number being treated. We shall have to see to that, not by reducing the number joining it but by treating more.
Mr. Maples:
Is not the true reason why waiting lists are rising that real increases in spending under this
Mr. Dobson:
I remind the hon. Gentleman that, when the Thatcher Government came to power, about 750,000 people were on the waiting lists. The figure did not go over a million until that Government stupidly introduced the internal market, which contributed to lengthening waiting lists. The money we are spending this year includes £300 million more than the previous Conservative Government had budgeted for this year. That £300 million has been spent to ensure that emergency and urgent cases are properly dealt with. Next year, we intend to spend £1.9 billion, which is £1.2 billion more than the previous Government put in their Budget. If he is not satisfied with spending levels, he should talk to the right hon. and learned Member for Rushcliffe (Mr. Clarke), who was responsible for deciding those things.
8. Mr. Drew:
What proposals he has to improve working arrangements between health and social services before the report of the royal commission. [29322]
The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng):
A range of measures have been put in place, including the introduction of health action zones, joint health authority and local authority investment plans and a requirement for better joint arrangements for multi-disciplinary assessments. Partnership and collaboration were also key themes in "The New NHS" White Paper and the "Our Healthier Nation" Green Paper.
Mr. Drew:
I thank my hon. Friend for that answer. The Secretary of State has talked on a number of occasions of the Berlin walls between social services departments and health bodies. We have a particular problem in Gloucestershire because of a rise in the amount of bed blocking. Will my hon. Friend consider having pilot projects in advance of the royal commission to find out whether we can get a better working arrangements between social services departments and health bodies and to scrutinise how the money is being expended?
Mr. Boateng:
We are certainly sympathetic to pilot projects and will develop in several ways our initiative to improve working relationships between health authorities and local authorities. We started that work this winter and my hon. Friend's constituency--which has received £200,000 of extra money--is an example of how that work is being cemented. We know that health authorities and local authorities work better together. They want to work together better; we are giving them the means to do so.
Mr. Gill:
Does the Minister accept that the problem of bed blocking was entirely predictable and, therefore,
Mr. Boateng:
The hon. Gentleman really is hoist by his own petard: Conservative Members are responsible for Shropshire's current budget. We are open to representations from any Shropshire Member--indeed, I will soon meet a Shropshire Member and a chief executive. We want--as we have done in our response to winter pressures--to underpin the relationship between local authorities and health authorities. That is a matter not only of resources but of cementing the will to work together and of providing--as we will do--the legal framework to enable them better to do so.
Mr. Dawson:
Does my hon. Friend share my concern that, of 38 questions on today's Order Paper, this is the only one that even obliquely refers to the work of the social work profession? Does he agree that, despite the Health Committee's recent excellent scrutiny of the subject of children in care, the crucial work of social services requires more scrutiny? Will he consult other Ministers to determine whether there are other ways in which that work can be done?
Mr. Boateng:
I hear what my hon. Friend says, but questions are a matter for the House and for hon. Members. I am heartened by the work of the all-party Committees, which have shown that hon. Members are very interested in social care and are determined--as Ministers are--not only to give it a higher profile but, importantly, to create the circumstances in which health care and social care work ever more closely together.
9. Mr. Chidgey:
What plans he has to recruit more medical staff for the NHS. [29323]
Mr. Milburn:
We are recruiting more medical staff. We have also introduced a range of initiatives to improve not only retention but recruitment. We are currently considering the medical work force standing advisory committee's recommendation to increase the annual intake to United Kingdom medical schools by 20 per cent.
Mr. Chidgey:
Is the Minister aware that there is a shortage of 120 hospital doctors in the South and West health authority, which directly affects my constituents in Eastleigh? Is he aware that a recent parliamentary answer revealed a shortage of 1,600 hospital doctors, 8,000 nurses and 1,000 general practitioners across the NHS? Does he agree that that must have a direct impact on this winter's record cancellation of operations and on the fact that waiting lists for hospital places are climbing out of control? Is it not about time that the Government took the matter seriously and took some firm action to provide an NHS that is properly funded and properly resourced?
Mr. Milburn:
That is precisely what we are doing: we are putting in extra money this year. Next year, we will put in an extra £50 million to aid education and training of future doctors. However, it is not only a question money. The best recruiting sergeant for attracting more doctors into the NHS will be to restore doctors' sense that,
Sir Peter Emery:
In view of the general shortage of dentists, particularly in the south-west--about which, as the Minister will know, I have been in consultation with his Department--will he consider setting a capital allowance for dentists who wish to start a new dental clinic in areas where it is acknowledged that a clinic is required and allow that capital to be repaid over a 10-year period from the fees earned? The difficulty with starting a new clinic is often the capital cost. An allowance would surely be a way of easing the problem and would be preferable to introducing mobile dental clinics--which we have in my constituency and which must be nonsense in this modern age.
Mr. Milburn:
Perhaps I can reassure the right hon. Gentleman that, in part, that is precisely what investing in dentistry does; it makes available to dentists and health authorities that want to work in collaboration grants for improvements to premises and, in some cases, for construction. The deal we offer dentists is that they can come back into the NHS and get a grant for doing so, provided they give a three or five-year commitment to continue in NHS dentistry. I assure the right hon. Gentleman that, of the 200 applications we have received under investing in dentistry, 73 have come from the South and West health authority area, and they will be considered seriously.
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