National Health Service

Part of Opposition Day – in the House of Commons at 9:20 pm on 20 November 1996.

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Photo of Tessa Jowell Tessa Jowell Shadow Spokesperson (Health) 9:20, 20 November 1996

I begin by declaring an interest: I have for four years been a member of the parliamentary panel of the Royal College of Nursing.

In winding up the debate, I want to address three issues. The first is the damaging gap between what is actually happening in hospitals up and down the country and the fantasy world in which the Secretary of State and other Ministers believe. Secondly, I shall address the way in which the internal market and fundholding have destroyed a founding principle of our national health service: that patients are treated according to their need, not their ability to pay or any other consideration. Finally, I shall address the transformation of the culture of the national health service as a result of Government reforms from a public service culture to one that apes that of a commercial organisation.

The debate has demonstrated beyond doubt the scale of the crisis facing our health service this winter. We have heard eloquent evidence from my hon. Friends the Members for Blaenau Gwent (Mr. Smith) and for Morley and Leeds, South (Mr. Gunnell) about the real difficulties facing their constituents in securing treatment this winter. We have heard my hon Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) describe the great fears of his constituents about the pre-emption of revenue by the large private finance initiative scheme in east London.

We also heard a surprising confession from the hon. Member for Wimbledon (Dr. Goodson— Wickes), regretting his failure to join us in opposing the devastation of London hospitals four years ago. He eloquently described the medical and academic vandalism that was inflicted at that time—a loss to the capital's medical resources that will be hard to recover.

I want to pick up the reference made by my hon. Friend the Member for Preston (Mrs. Wise) to the iniquity of mixed sex wards and underline the enormous concern about the persistence of such wards in psychiatric hospitals. About 50 per cent. of women who are admitted to psychiatric hospitals have, at some time, been victims of sexual abuse. Research has shown that and shown how damaging to their well-being is the fear of vulnerability to and the possibility of sexual attack while in hospital. There is an urgent need to phase out mixed sex wards and the experiences of women in psychiatric hospitals and of men and women in general wards bear testament to that.

More than anything else, the way in which this winter's crisis has been debated today has marked a clear dividing line between Government and Opposition. Ours is no longer a health service that treats people according to their clinical need—examples from throughout the country have emphasised that. The Government have created that set of circumstances and now shrug off responsibility, saying that the circumstances result from local decision.

The NHS is fast becoming an emergency-only service—a safety net service for those who are acutely ill, while waiting lists lengthen. The crisis—the uncertainty that has been created for patients this winter—is being managed by nods and winks.

We hear reports that regions are telling trusts not to pay creditors after February, as a way to tide things over. I am happy to give way to the Minister if he can confirm that the Government do not intend to break the agreement that creditors are paid within 30 days. I see that the Minister does not wish to answer that point.

Regions are telling trusts that waiting lists should be allowed to lengthen, and that decisions as to how to manage the crisis are down to local managers, so that those who are responsible for the shambles—Ministers—stay as far from blame as possible. It amounts to something when the chief executive of the national health service executive sends a letter to trusts about handling the winter crisis, stating emphatically that it is not a new set of instructions or requirements.

Making the noise, as it is termed, is left to the Secretary of State, as he briefs the media and persuades Tory-supporting chairs of trusts to join his new NHS Network, using their position as public appointees for naked electioneering.

Someone who obviously is not a member of the Tory good news brigade is the chair of the Queens Medical Centre, Nottingham, University Hospital NHS trust. As my hon. Friend the Member for Nottingham, East (Mr. Heppell) said, he has been vocal in expressing his anxieties about his trust's capacity to treat patients this winter.

What is happening at the Queens medical centre in Nottingham helps us to understand the distortions in the health service. On 1 November, the centre stopped taking any routine elective admissions from non-fundholding GPs. As only 23 per cent. of Nottingham's population is covered by fundholders, 77 per cent. of the population now cannot have surgery unless they can be admitted as an emergency. That means that the centre has empty beds, so nearby Derbyshire, where 90 per cent. of GPs are fundholders, is referring its patients for treatment in the empty beds.

In 1990, the reforms were introduced with much-vaunted claims that the money would follow the patient. Patients now follow the money—where their GPs are fundholders. The chances of getting elective surgery done before next April are increasingly remote anywhere in the country unless a person is the patient of a fundholder, regardless of what is wrong with him.

King's College hospital provides a local example of the two-tier national health service, described as "an everyday reality" by Derek Smith, the chief executive. At the public meeting earlier this year, he said: Having succeeded in driving down waiting lists for all patients to twelve months it is with regret that we now see waiting times rising again for patients from Lambeth, Southwark and Lewisham. We are a national and regional centre of excellence but we live and work at the centre of our local community from which patients have longer waits than those from outside the area.This is in effect a two-tier NHS…the last few years King's has seen major expansion and development as part of an ongoing modernisation programme. We have new, high-tech facilities such as our day surgery centre which is under-used while there arc patients on waiting lists that it can care for. A surgeon at King's College hospital, which treats my constituents, recently sent me a letter that had been circulated to all senior registrars, registrars and consultants in the surgery and critical care groups. They are working closely with the marketing department to attract additional ECRs and fundholding GP activity. They are concerned to draw attention to the clinical urgency of some of the cases that will face extended waits as a result of insufficient contract volumes. That is especially pronounced in neurology, where many cases involve following up, treating or diagnosing cancer.

The vascular clinic will now, on Wednesday mornings and Friday afternoons, book in only the patients of GP fundholders and extra-contractual referrals. I should like Ministers to tell me how I can justify all that to my constituents.

Of course people suffer as a result. The need for routine surgery becomes a necessity for emergency treatment when, for instance, a man with angina has a heart attack, or a man with prostate problems becomes unable to pass urine. A cardiologist in Bedfordshire recently observed that his patients waiting for heart surgery are more likely to die on the waiting list than they are to die of the operation.

There is another inequity in the system. Fundholding GPs do not have to meet the costs of emergency treatment for their patients. As emergencies increase, therefore, the costs are a further drain on the resources of health authorities, not fundholders. So health authorities are faced with an increasing number of emergencies and with meeting, where possible, the costs of elective surgery for the patients of non-fundholding GPs.

All this represents more broken promises. Moorfields Eye hospital has just extended its out-patient waiting time to 26 weeks, in clear breach of the patients charter standard of 13 weeks.

This may be bad news for patients; it is certainly good news for private providers and the insurance companies, for which insecurity and lengthening waiting lists are the best possible recruiting sergeants. Increasing numbers of people are paying twice for their health care. What is so damaging is that no one in the Conservative party takes the problem seriously. The Government live in a world of make-believe. Most recently, the Secretary of State published a White Paper setting out, as he called it, his credo for the national health service. In it we read fairy tales about the triumphs of the NHS. There have certainly been some triumphs, but they are achieved by the dedication of staff—despite, not because of, this Government.

The White Paper failed to mention elderly patients waiting on trolleys or patients re-admitted after premature discharge—or lengthening waiting lists, cancelled operations or the winter crisis. All these are the daily facts of life for staff and patients alike. Furthermore, there was no mention of those great Government icons: competition and the market. The Government believe that they have been a howling success. They should perhaps take seriously the findings of the recent "British Social Attitudes" survey. When asked whether they thought that the health service had improved, 81 per cent. of those interviewed said that they saw no improvement and 49 per cent. believed that things had got worse or much worse.