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Mr. Dobson: No, I will not give way at the moment.
To do that we need clearer national standards, applicable throughout the NHS. We need national standards because patients are not willing to put up with variable quality and second best. That is why we are setting up what we call NICE--the National Institute for Clinical Excellence. It will draw up authoritative guidelines on a wide range of treatments and conditions, and so help to ensure that patients everywhere get faster access to treatments that work well.
The National Institute for Clinical Excellence will be professional-led. I have appointed as chairman designate Professor Michael Rawlins from Newcastle university, the Royal Victoria infirmary and the Freeman hospital, Newcastle. I promised the medical profession that we would appoint someone who commanded its support and respect. As I made the announcement at a meeting chaired by the chairman of the BMA who said that I had done exactly what I had promised, I am confident that Professor Rawlins is the man for the job.
We are also going to launch a rolling programme of national service frameworks, which will set out "service blueprints" for major conditions. To be fair, the previous Government established one national service framework for cancer, and it is developing well. We have established one covering children's intensive care, and we are now working on heart disease and mental health. For the first time ever, the NHS will have clear standards in each area, spanning primary, secondary and tertiary care.
Of course, it is no good having standards if they are not implemented and monitored. Above all, this needs action locally, within primary care groups and local hospitals. That is why our national health service Bill will place a legal duty of quality and "clinical governance" on every NHS organisation. In future, all hospital doctors will have to take part in national external audit, and we shall work with the professions to modernise the system of
self-regulation so that it is able to command the confidence of the public. It has to become more effective, more open and more accountable. It cannot operate in isolation, but must form part of an integrated approach to raising standards.
All this will be backed up by a new commission for health improvement. Patients themselves will be represented on the commission, and its findings will be published. It will be responsible for checking on the standards of every trust, and it will have statutory powers to investigate concerns about clinical quality and to report on the clinical governance of trusts. In extreme cases, it will be able to recommend to the Secretary of State that new teams of experienced doctors, nurses and managers are sent in promptly to take over the running of any service that is failing.
I must make it clear that none of this is designed just as a clampdown on poor performance after the event; it is designed to ensure high standards in the first place, and to nip problems in the bud before they ever do patients harm. At its bluntest, what patients want is a system that prevents future tragedies like that at Bristol before they happen, not one that just apportions blame and punishment afterwards. That is what the NHS Bill is designed to do; that is why it commands the support of the profession; and that is what we are determined to achieve.
Mr. Brady:
I am grateful to the Secretary of State for giving way eventually. It was apparent to all in the House why he was so evasive at the point at which I first sought to intervene. Will he take this opportunity to make it clear that, when patients are pre-booked for operations or in-patient treatment, of which he has made so much, they come off waiting lists--sometimes several weeks before an operation?
Mr. Dobson:
As the pre-booking system that I have just been describing has not yet begun, it is a little difficult for the hon. Gentleman to say that such things are happening already. The system is entirely new; people on the list are clearly waiting for treatment. Let me make it clear--
Mr. Dobson:
The definition that we inherited from the previous Government is that people who are waiting for treatment go on waiting lists if they are fit and immediately available for surgery, even if they have a booked appointment. I see no reason to change that. The hon. Gentleman should not peddle another misleading approach. You can see how evasive I am, Madam Speaker.
The NHS Bill will cover a wide variety of measures to improve the quality of treatment and care in every part of the country, and will change the law to improve co-operation between the health service and local social services. All that will be spelt out in due course.
We propose two legislative changes to protect the taxpayer and the health service's funds. The pharmaceutical price regulatory scheme is being renegotiated. To date, the scheme has been voluntary, and I hope and expect that we shall be able to reach another
voluntary agreement with representatives of drug companies which meets their legitimate objectives as well as those of the NHS. We have, however, decided to seek reserve powers to ensure that all companies subsequently comply with the agreement. That should have no significant impact on the vast majority which always have complied and are complying at present. It is directed at a small minority of maverick companies. We estimate that their failure to comply has cost the NHS £28 million this year. That cannot be allowed to continue; it must be stopped.
As announced by the Chancellor of the Exchequer, as long ago as his first Budget last year, we will amend the Road Traffic Act 1988, passed by the previous Government, to make it easier for hospitals to collect from insurance companies the money that they have been entitled in law to collect since the 1930s. The present arrangements simply do not work and, as a result, the NHS is losing a huge amount of revenue. We do not know how much; estimates vary from £30 million a year to more than £500 million a year. Whatever the figure, the extra funds for the NHS will be very useful.
Miss Widdecombe:
Will the right hon. Gentleman give way?
Mr. Dobson:
The right hon. Lady should let me finish. There are two charges under the present law: an emergency treatment fee of £21.30, which is supposed to be collected at the hospital directly from any motorist who has been involved in an accident. That raises very little, asking for it causes great offence and it is not what NHS accident and emergency staff are there for. The Tories promised to abolish it, and broke their promise. We will abolish it.
The other charge is levied on insurance companies when a motor accident victim makes a successful claim for compensation. At present, it covers the cost of out-patient treatment up to £295, and the cost of in-patient treatment up to £2,949. That money should have been collected in the past; it was not, but it will be from now on, and I am glad that we are doing it. Apparently, the right hon. Member for Maidstone and The Weald does not want me to give way any more.
Under the Tories, the health gap between the well-off and the badly off widened. It was a shameful consequence of 18 years of Tory rule. The Government are determined to narrow that health gap. In July 1997, shortly after taking office, I invited the former chief medical officer, Sir Donald Acheson, to conduct an inquiry into health inequalities in Britain. I did so because I was determined to make an early start on our mission to reduce health inequalities the top priority in our overall programme to improve the nation's health. Today, I welcome his report. It is a further stage in our unprecedented programme to tackle inequalities in health.
No previous Government have ever set themselves such ambitious targets, but we are confident that we can succeed, because the whole Government are taking action. Led by the Prime Minister, all members of the Cabinet are working together to tackle the problems that make people ill.
Poverty is a principal source of ill health. Poor people are ill more often, and die sooner. Our tax and benefit changes, the working families tax credit and the minimum
wage mean that work will pay a guaranteed minimum of £190 a week for a family. That will guarantee a minimum income of at least £5.50 an hour for a lone parent in work with one child, and £6.37 an hour for an adult with two children.
A poor start in life is bad for health. Our £540 million sure start programme, under the supervision of my right hon. Friend the Minister for Public Health, will give young children and their parents the child care and support that they need, so that every child in our country is given the best possible start in life.
A decent education sets people up for better health in later life. Earlier this month, as part of our work to drive up standards in schools, we announced an extra £250 million aimed at children who are disaffected with their schools and with society in general. That should help them.
Being old and cold in winter because of a lack of money to buy warm clothes and good food, and being afraid to turn the fire on, is bad for health. Our £2.5 billion boost to pensions will ensure that the poorest pensioners are the biggest winners, with a guaranteed minimum weekly income of £75 for single pensioners. That will drive up health standards, as will our plans for annual winter fuel payments, the £150 million investment in home energy efficiency, the availability this winter, for the first time, of flu jabs for all those over 75, and the scrapping of the Tory charges for eye tests for pensioners.
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