I begin by thanking the Minister for his courtesy in seeing me earlier this week. For each of us it was a useful dress rehearsal for the debate.
There are two root causes of the health service crisis in West Worcestershire and, in particular, of the problems facing my constituency. The first is the extraordinary overspend by the Worcestershire Acute Hospitals NHS Trust, especially by the new Worcestershire Royal hospital. The second is the retrospective decision last year by the Government to cap the funding of eight out of 13 South Worcestershire primary care trust GP-based capital projects.
Since the national health service is a centrally directed public service funded almost exclusively by the taxpayer, the Government must ultimately take responsibility for a situation that in Worcestershire threatens to cut the present quality of health services. That is despite the fact that the Government have raised taxes, ostensibly in order to provide for better health services. Worcestershire is a good example of the coincidence of taxes going up steeply and the quality of services threatening to decline.
Two particular matters are currently in the forefront of the minds of many of my constituents. The first is the question of the threat to the provision in my constituency of new GP medical centres in Malvern, Upton-upon-Severn and Pershore. These centres were part of a list of 13 projects submitted for approval by the Government, of which only five were actually approved. The Government argue that at no time did they indicate that all 13 would be approved. I am told that that does not accurately reflect the practice that was in place before the Government changed the rules, in this instance after some of the preparatory contracts had been placed.
The position before the rules were changed was that the non-cash-limited programme received almost automatic approval once it had been cleared by the local health authority. This may not have been good practice, but it was the system under which health authorities made their plans and let out their contracts. I do not necessarily quarrel with the Government's judgment in tightening these rules. I do question the way in which they did it. What has thrown the system in Worcestershire into disarray has been the fact that the new rules were introduced without warning and with a retrospective effect on local plans and contracts. I understand that that may even have made the South Worcestershire primary care trust liable to be sued for damages.
One particular GP practice scheme has been put at risk, and if it does not go ahead it will have a severe knock-on effect that could threaten the building of the new community hospital at Pershore. Capital has been allocated for the building of the Pershore hospital by the Wychavon district council on the basis of the return in rents from the hospital itself and the medical centre that is to be housed in the overall premises. Without the rent from the medical centre, which is now under threat, the building of the hospital is unlikely to go ahead, at least for the time being. That will cause grave anguish and if it happens it will be a tragedy for the people of Pershore, who deeply value their existing community hospital and who have been led to believe that a start to building a new one will be made later this year.
The Government now say that it is up to the strategic health authority and the primary care trusts in Worcestershire, Warwickshire, Coventry and Herefordshire to prioritise their investment projects within the overall budget. As a matter of fact, they are trying to do just that in a meeting that is going on as we speak. The task would have been made immensely easier if the policy had been introduced in a less erratic fashion and with proper warning. False hopes would not have been raised and contracts would not have been entered into. Those involved would have been able to plan on a more realistic basis. As it is, an immense amount of work has gone into preparing the projects, some of which will, presumably, be delayed well into the future at best. Frankly, that is not good enough. The Government should be prepared to reconsider their position—certainly with respect to the four medical centres that it had been thought would be built in my constituency over the next few months. Under the old rules, they certainly would have been.
The second big issue facing the health service in Worcestershire is the uncertainty that now surrounds the future of the general practitioner contracts, which were signed nationally months ago. The Government and their local agencies are legally committed to them. In the case of Worcestershire, there is grave doubt on the part of health officials—and, indeed, among the doctors themselves—about how the contracts are to be fully implemented.
Three aspects of the contracts are causing particular concern. First, there is the so-called quality formula, by which doctors are paid for achieving standards in respect of a range of some 1,050 quality points. Some might argue that that is a pretty bizarre way of paying doctors, but it is what the agreed contracts say. The particular problem for the South Worcestershire PCT is that funding the quality aspect of the contracts is based on the notion that doctors will achieve, on average, 750 quality points. In Worcestershire, where the quality performance has been high, doctors are averaging around 900 points. That alone is putting pressure on the PCT budget.
Then there is the vexed question of out-of-hours service. There does not seem to be even a basis for an agreement here. It is not yet clear how many GP practices want to take part in the service—or, critically, at what hourly rate. Some people are talking about £80 an hour to cover the cost of doctors being called out at night, but the PCT does not have the funds from central Government to pay those rates without cutting other services. The same is true of the more discretionary elements in the contract, such as preventive counselling services, GP operative services, drug abuse prevention and so forth. Each of those and similar discretionary services are at risk—at least in their present form.
I am told that all this adds up nationally to underfunding the agreed GP contract arrangements to the tune of about £1 billion. If so, this is another example of central Government laying down detailed targets and directions without providing the necessary funding to meet them.
The Worcestershire health service has a particular problem, in that it must try to meet the requirements in the context of closing an acute hospital deficit of more than £200 million for a two-year period. It is no good the Government passing all the blame to its local agents—for that, in a nationalised health system, is exactly what they are: local offices of a central Administration. Under a centralised command system—which is what the NHS is, however it is dressed up—the responsibility lies at the centre and with the Minister. This is especially true of a Government prone to setting detailed targets and giving strict instructions on objectives. Such a Government are especially ill suited to claiming that it is someone else's fault down the line when things go wrong, as they certainly are in Worcestershire.
It is true that more money has been allocated, but the problem is that the imposed costs have grown faster than the revenue. For this reason, there are now the makings of a financial crisis in the health services in Worcestershire, and it is the Government's job to find a way out.
Matters may not be quite so dire where the finances are to an extent ring-fenced. An example is the proposed building of a new community hospital in Malvern. In this case, a business plan can be created whereby the proceeds of the sale of the existing hospital are applied to make the project viable. The Minister need merely give the plan his blessing and encourage all concerned to implement it as soon as possible—preferably within the next few months.
As for the rest, the Government must either lower their sights and shut down the rhetoric and hyperbole, or up the ante, which will mean even higher taxes. This is a dilemma of their own making: it was they who claimed that the nation's health problems would be cured simply by throwing more money at them. Live by spin and die by spin. The problem for the Government is that the reality has taken over from the spin. In Worcestershire at least, the money has not matched the rhetoric and there is now a crisis in the health service. I look forward to the Minister's response.