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Private Finance Initiative
10. Mr. Laxton: What progress has been made in the PFI hospital building programme since 1 May. [29324]
Mr. Dobson: Before the general election, the tired old Tory Government spent more than £30 million on legal and other fees for the private finance initiative programme but did not make a start on one hospital. Since May last year, I have authorised progress on 17 new hospitals. Building work has already started at Dartford and Gravesham; Carlisle; Norfolk and Norwich; and the two hospitals in South Buckinghamshire.
Mr. Laxton: Does my right hon. Friend agree that the centrepiece of this Government's legislation is to start, through the private finance initiative, to build the hospitals that the previous Conservative Government only promised? Does he further agree that whereas, if I can use this phrase, the previous Government were all mouth and no trousers, he is mouth and trousers?
Mr. Dobson: I am not sure whether that is a compliment or an insult, but I shall assume that it is a compliment as it comes from our side of the House.
Besides the hospitals that I have just mentioned, where building work has already started, we expect work to start fairly soon in North Durham and Calderdale; within a
foreseeable period at Hereford, Wellhouse, Greenwich, Worcester, South Manchester, South Tees, Bishop Auckland, Swindon and Marlborough and Bromley; and, following the outcome of the Turnberg review in London, at University College hospital in my constituency, at St. George's, the Royal London, King's and Oldchurch. That is not bad going considering we have not yet been in office for a year.
Sir Sydney Chapman:
As the previous Government gave the go-ahead for the development of phase 1b at Barnet general hospital and the new Government have decided not to reopen the accident and emergency department at Edgware, and understanding that the new Government wanted time to review all the hospital building programmes, will the Secretary of State tell the House when construction work will start on phase 1b at Barnet general hospital?
Mr. Dobson:
I cannot, but I will write to the hon. Gentleman with that information.
11. Mr. Rammell:
What changes he intends to make to the current role of NHS trusts in shaping local health care. [29325]
Mr. Milburn:
National health service trusts will be brought in from the cold and given back their place in the shaping of local health services. In place of competition, NHS trusts will work with the rest of the local health service to plan and deliver the best possible services.
Mr. Rammell:
My hon. Friend will be aware that, under the old Tory NHS, trusts often slashed their costs on an unsustainable short-term basis to drive the so-called competition--other hospitals--out of business. Will he confirm that, under Labour's new NHS, that approach will not be acceptable and that co-operation rather than competition will be the way forward? Co-operation was one of the founding principles of the NHS, and that is what the Labour Government are bringing back to the NHS.
Mr. Milburn:
My hon. Friend is absolutely right. We start from a simple premise: one cannot treat hospitals as if they were supermarkets. The old internal market that the Tories unleashed on the NHS set not only doctor against doctor but hospital against hospital. All that is being swept away; in its place there will be partnership and co-operation, which will truly benefit patients.
Mr. Flight:
The new primary care commissioning groups will have a major role in shaping local health care in the future. The only area over which community health councils have no powers is general practice. Will the Minister consider imposing some obligation on primary care commissioning units to consult CHCs in the management of the provision of care?
Mr. Milburn:
That is an extremely important question. We want the new primary care groups and trusts to be representative of, and properly to engage with, their local communities. That is why we determined that the boards of the groups and the trusts should include representatives
Mr. Sutcliffe:
Will my hon. Friend consider the actions of hospital trusts? The Government are doing excellent work in opening up the partnerships, but will he examine the management costs that trusts are still incurring on administration and premises, as there has been no decrease, particularly in areas such as Bradford?
Mr. Milburn:
The Government have instituted two important policy developments. The first is to cut the money spent on bureaucracy and to ensure that front-line patient services receive the savings from cutting red tape. As my hon. Friend will realise, the White Paper proposes that we shall save £1 billion as a result of moving away from the discredited and expensive internal market and reintroducing to the NHS a partnership approach. Secondly, we shall consider favourably any trust mergers that are proposed, provided that they are in the interests of patients and that they release at least £500,000 from bureaucracy to front-line patient care. That is what patients deserve and staff want.
12. Mr. Swayne:
If he will make a statement regarding the regional availability of Aricept in the NHS. [29326]
Mr. Milburn:
Information about the prescribing of Aricept in the national health service is available only for prescriptions dispensed in the community in England; in many health authorities, these will have been issued in hospitals. Available data show that prescriptions have been dispensed in 99 of the 100 health authorities in England. However, I understand that many health authorities are reluctant to commit resources to the drug because of the perceived lack of evidence about its clinical and cost-effectiveness.
Mr. Swayne:
Will the Minister say what a patient should do when the general practitioner advises him--or, more likely, one of his relatives--that the condition would benefit from the prescription of Aricept but that, under the local regime, that is not possible? Should the patient move house?
Mr. Milburn:
The hon. Gentleman raises an extremely important issue, with which I think the whole House will sympathise. Alzheimer's disease is among the most distressing of medical conditions, not only for the sufferers, but perhaps particularly for the carers and close family. However, there is no instant, miracle cure and there is certainly no wonder drug either on the market or about to come on the market. Published data show that Aricept has a limited beneficial effect on the symptoms of the disease. It is important that hon. Members, from whatever party, do not raise unrealistic expectations about the ability of this or any other drug to deal with this severe, debilitating and ultimately fatal condition.
Dr. Harris:
The hon. Member for New Forest, West (Mr. Swayne) raises a wider question--the availability of treatments apparently by postcode rather than by
Mr. Milburn:
The hon. Gentleman is right--there is a disagreement between my party and his on the funding of the national health service: his party wanted to put in less money. On rationing by postcode, it is important that we put the issue into perspective. For most patients in most places for most of the time, most services and treatments are available on the national health service. We should say that loudly and clearly, and we should celebrate it, because it is a success story for the NHS. However, we want to build on that and, as the hon. Gentleman is aware, our proposals in the White Paper for a national institute of clinical excellence and for national service frameworks are intent upon bearing down on unacceptable and unjustifiable variations in performance and availability of service. We want a genuinely national health service to be available to people.
13. Ms Jenny Jones:
What steps he plans to take to improve the monitoring of outcomes and the quality of patient care after the abolition of the NHS internal market. [29327]
Mr. Milburn:
"The New NHS" White Paper set out our new approach to assessing and monitoring performance, focusing on the quality, effectiveness and outcomes of care. It incorporates a range of indicators that encompass health outcomes of NHS care and effective health care delivery. We are currently consulting on the detail of this approach.
Ms Jones:
Can my hon. Friend assure the House that, in the initiatives that he has announced, quality of care will now take precedence and we will get away from the old days when number crunching and making the tables look right was more important than quality? Can he also assure the House that quality of care will also take precedence in the NHS complaints procedure?
Mr. Milburn:
I can certainly give my hon. Friend the latter assurance. Under this Government, standards are as important in health as they are in education. There have recently been recurring problems with standards and quality in the NHS, particularly the difficulties with hip joints and the dreadful problems affecting screening services in Kent and Canterbury Hospitals NHS trust. If we are genuine about wanting a one-class, first-class service, we should no longer be willing to tolerate what is, frankly, second best.
Mr. Boswell:
While the Minister is considering outcomes, will he acknowledge that unless people can get off the waiting lists and into treatment there is no question of outcomes? Given the sensitivity of the issue, will he give the House an assurance that there is no question whatever of manipulating the figures by allowing patients off the waiting list either because they have died or
Mr. Milburn:
I have to say to the hon. Gentleman, for whom I have a great deal of respect on this and other issues, that if patients have died I do not see why they should remain on NHS waiting lists. As for manipulating the figures, I remind him that it was his party, not mine, that was most adept at manipulating figures--certainly the unemployment figures.
Mr. Flynn:
Does my hon. Friend agree that the crisis affecting hip replacements was entirely predictable and inevitable and resulted from the market free-for-all that was extremely profitable for the 60 companies that produced new hip prostheses when two very reliable ones--the Stanmore and the Charnley--were already on the market? Will one of the Government's major reforms be to change the health service so that the emphasis is not on making money or on the quantity of the service, but on the quality of the service?
Mr. Milburn:
My hon. Friend is absolutely right that in future the emphasis will be on quality, quality and quality. It is quality that counts, quality that patients experience, and when quality goes wrong it is the patients who suffer.
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