NHS (60th Anniversary)

No, I am making progress and I want other hon. Members to be able to speak. Hon. Members of all parties should ensure that there are opportunities for innovation. As we understand from Derek Wanless's reports and his revisions to them, there are substantial risks to the future of the NHS, not least those that arise from demographic change, the impact of new technologies and the costs associated with implementing them, and rising expectations and demand. However, central among those risks are the impacts of public health demands, if we are unable to achieve what he describes as a fully engaged scenario, whereby the public understand the health implications, including obesity and sexually transmitted infections, of behaviour such as alcohol abuse, substance misuse and the like. Unless the public recognise that, it will be very difficult for the NHS to cope with the disease consequences that will arise. When Ministers publish the review next week, I hope that they will make it clear that it is outrageous that in London, for example, as Lord Darzi set out in ““A Framework for Action””, there is an inverse relationship between the relative deprivation of primary care trusts and the amount spent on preventive health care. Indeed, we have set out clearly how our public health infrastructure should be geared to that, and how we should have separate public health spending. Right across the country, there is no positive relationship; indeed, the average spend per head in primary care trusts on preventive health care spending is just £20, from an average allocation to PCTs of well over £1,000 per head. That is the second lesson. The third lesson that we must learn is about giving the NHS organisational stability. My right hon. Friend the Leader of the Opposition happily said that, and the Secretary of State repeated what he said when he took office—that there should be no further major organisational upheavals. I will not dwell on all the things that have happened, but even now the NHS does not know whether it is working to the NHS plan from 2000, to ““Keeping the NHS local”” from 2004, to ““Commissioning a patient-led NHS”” from 2005, to ““Your health, your care, your say”” from 2006 or to whatever is contained in the document to be published next week. There is no thread of consistency and stability in either the structures or the policy being pursued in the NHS. One of the first things that many people working in the service would say to us, as we collectively discuss the NHS after 60 years, is that they will be able to deliver so much more in the future if they are given the stability of a framework in which to do so and the freedom to respond to the needs of patients.