National Health Service

Part of Opposition Day – in the House of Commons at 6:35 pm on 20th November 1996.

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Photo of John Heppell John Heppell , Nottingham East 6:35 pm, 20th November 1996

My hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) spoke about the good news club that has been formed by some Conservatives. It seems that every Conservative Member who has spoken today has been a member of that club, because the national health service they talk about is not the NHS that I recognise. The only time they talk about anything bad is when it is something that happened in 1975.

I remind those hon. Members that 1975 was 21 years ago; many of the people who will be voting at the next general election had not even been born then. Even if I accepted their criticisms about what happened in 1975—which I do not—I would have to tell them that it was a different health service then, at a different time, with different needs and different economic circumstances.

In the 21 years since 1975, we have had 17 years of the Conservatives in office. If the news is all good, why do we still have 1 million people on the waiting list, year after year? Why have 250,000 people been on the waiting list for more than six months? Why, last year alone, did almost 55,000 people effectively have their operations cancelled at the last moment? Nobody can tell me that that is good news.

I do not want to bandy national statistics with the Minister, because, whatever statistic anyone mentions, he will find a different one. The Minister is obviously a proponent of the idea that there are three types of mathematician: those that can count, and those that cannot. The penny will drop in a minute.

I want to talk about the reality of what is happening locally in my patch. The right hon. Member for Sutton Coldfield (Sir N. Fowler) talked about how trusts could respond quickly to events. He is right, and I know a good example of how they respond quickly—an article in my local paper, saying: Cash crisis axes more ops … City Hospital and QMC' — Queen's medical centre— are forced to postpone routine operations". That is how they act quickly, because they are running out of money.

For November and December alone, the Queen's medical centre has postponed 350 operations that people were expecting. The city council has stopped all routine, non-emergency operations, because more emergency operations are needed than it thought, and it has effectively no contingency in its budget to meet the demand.

Unless there is extra money for Nottingham health authority, it is predicted that next year no medical equipment will be replaced. Plans to introduce the latest treatments and develop breast cancer services will be dropped. The waiting list for routine operations will grow even more. All high-cost treatments will have to be restricted. National standards for the ambulance service will not be met. There will be no contingency plans, because there will be no contingency fund; there will be no money.

The Minister may think I exaggerate, but these are not my predictions but those of the chairman of the Nottingham health authority, Sir David White, who is not a noted socialist. He was knighted by the Government. He is one of the kings of the quangos. The Government not only think that he is good enough to chair the health authority; he is on almost every conceivable quango for the Nottingham area. He is not noted for his criticism of the Government. However, he is publicly saying that all those things will happen next year. He says that part of the reason is that Nottingham has been underfunded for many years. It is funded at 97 per cent. of the average, when, because it is a teaching district, it should be funded at more than 100 per cent. The gap between 97 and 100 per cent. funding is £11 million.

The confusion in the Government about how to deal with the problem is interesting. In February, the Secretary of State agreed that there was underfunding, although of £9 million rather than £11 million. The hon. Member for Gedling (Mr. Mitchell), who has since become the Minister responsible for the Nottingham area, said that the underfunding dated back to the 1960s, and could not be solved overnight. I did not expect anyone to solve it overnight, but if it dates back to the 1960s, I should have thought that the Government might have tried to tackle it in the years since 1979.

That was not the end of the story. Only weeks later, the Prime Minister contradicted the hon. Member for Gedling, and said that there was no underfunding. He said that the health authority had made it up so that it could bid for more money. Within a week of the Prime Minister contradicting the hon. Member for Gedling, a junior Health Minister, the hon. Member for Orpington (Mr. Horam), said that there was underfunding, and that there was a battle to address a £7 million deficit this year. Finally, the Secretary of State agreed on 12 November that there was underfunding, and gave a hint that some more money might be made available to the people of Nottinghamshire.

That is all well and good, but how am I to tackle the letters I get from people who have been told they cannot have operations? I want to be able to tell them who is responsible for the failure to give the public the service that they deserve. Who is responsible for ensuring that patients get treated and for looking after the sick? Should I tell them that it is the Government and the way that their policies have changed the health service that has put those people in that position?

Should I say that the health authority or the trusts have handled it badly? I have some difficulty with that, because many of the people on the health authority and the trusts are Tory placemen. They are guilty only of doing what the Government want—and doing it with enthusiasm. It is difficult to blame them entirely for the problem. The blame rests fairly and squarely with the Government.

If underfunding, which we have had since 1960, is the only problem that has caused the crisis in Nottingham, why have we not faced such a crisis before? Underfunding may be part of the problem but the real problem has more to do with the changes that the Government have made: the internal market and the growth of bureaucracy. The Government talk about increasing spending year year on year, but £1.5 billion is being spent, year on year on year, on extra bureaucracy. That money must come from somewhere, and it comes from services.

There are fewer doctors and nurses and more accountants and managers. Last year alone, there were pay rises of 18.5 per cent. for senior managers, while for nurses the figure was only 3 per cent. Many people in the health authorities and trusts have watched things going wrong for some time and have not spoken out.

That is what I accuse them of. They are guilty of complicity, of not making criticisms. They have not been willing to speak out until now. The hon. Member for Gedling said that the present position had not been reached overnight. It has been known about for years, and the authority managed to survive because of the reserves it built up before the Government made their changes.

One group that I do not want to criticise is health service staff. The nurses, doctors, auxiliary staff and ambulance drivers deserve praise, not criticism, because they have been putting off the crisis, and they are still putting it off in many hospitals. They have kept the NHS as good as it is—despite, not because of, the Government. The staff will have to bear the consequences of the failure of the Government, the health authority and the trusts. The financial pressures on Queen's medical centre, which is running a £1.6 million deficit, mean that staff have been told that, because the centre's budget is 70 per cent. of costs, many of them may be made redundant. Many people who should be rewarded are suffering.

I have one more point on the local situation. I have tried to keep off the national situation, which other hon. Members understand better. Part of the reason for the present crisis is the Government's private finance initiative. It has been developed in such a way that short-term financial gains can be made, but only with long-term financial consequences. It is selling off the family silver.

For example, on 7 December last year, Nottingham health authority opened its refurbished headquarters, at a cost of £4 million. I think that it was opened by the Chancellor of the Exchequer. I objected that I was not sure that that was a good way to spend money when other services were under threat. It is on Standard hill, an historic site in the centre of Nottingham. I did not know that the authority already had plans to sell it. I was amazed after the grand opening to find that out, not from the health authority but from a leak.

I asked the chairman of the health authority why the public did not know anything about it. He said, "You should know about it, because it is in the public domain." I then asked to see the discussions in the minutes of the multi-million pound deal to sell the headquarters building, the staff, fixtures and fittings, and then rent them back. But those matters had not been discussed. The massive deal did not appear anywhere on the health authority's public agenda, although it had been in process for more than a year.

The deal was only placed in the public domain through an advertisement in the Estates Gazette. My constituents do not spend their time browsing through that gazette to see whether the health authority is planning to sell buildings for £4 million or £5 million—the story is that it is to be sold for £4 million. If £4 million is spent on refurbishing something that is then sold for £4 million, it is being given away. The public in Nottingham have a right to object to that, but they cannot object, because they do not know about it.

I am amazed that, when the Government drafted new guidelines to ensure greater openness in the NHS, they said—in the annual report for 1994–95: In its turn, accountability demands openness. Adding to existing codes of conduct and accountability, a new code of practice on openness for the NHS was published in April 1995. Its key principle is that information should be publicly available unless there is a good reason for confidentiality. It continues to outline what people are expected to do under the code of practice.

When I was questioning the chairman of the health authority, he told me that lawyers had been brought in to see how little he could tell me. He said that he could tell me everything that was happening, as long as I made a vow of confidence and did not let the public know.

What is the Minister going to do to enforce his code of practice on openness and accountability? The chairman of the health authority has effectively told me that he is accountable to no one but the Secretary of State. I do not believe that; I believe that he is also accountable to the people of Nottingham—and to me.

Unless the people of Nottingham are told what is happening in relation to the private finance initiative, that accountability does not exist. The Government have turned the PFI on its head: and it has become the public finance initiative. The public sector chips in £4 million, which can then be passed over to a private company with no risk. When the Minister winds up, I hope that he will say what he plans to do about that.

It has become apparent in Nottingham that the trusts and the health authority try to operate no longer as services to the community, but as businesses. The board members are business people. I have no objection to trying to run things efficiently, effectively or cost-effectively, but the health authority and the trust need members who understand people's needs and not simply how to balance books.