I am delighted to have secured this important Adjournment debate on Lincolnshire's national health service at a time when a vital range of services and facilities across the county appear to be under threat as a result of cost-cutting measures necessitated by a funding shortfall.
The United Lincolnshire Hospitals NHS Trust is one of the largest hospital trusts in the country and serves approximately 641,000 people. Last year, the trust treated 175,000 accident and emergency patients, 500,000 out-patients and nearly 100,000 in-patients. The trust provides a comprehensive range of hospital-based medical, surgical, paediatric, obstetric and gynaecological services from nine hospitals across Lincolnshire, two of which are in my constituency.
Pilgrim hospital in Boston is a large district general hospital, with a 24-hour major A and E department and a range of specialities. The other hospital in my constituency is the Skegness and district hospital, which is a 39-bed community hospital with a 24-hour A and E department that deals not only with local residents but with a high tourist influx throughout the whole year. The two hospitals treat about 73,000 A and E cases and 150,000 out-patients each year. The East Lincolnshire primary care trust, which covers my constituency and the other eastern part of Lincolnshire, caters for 275,000 residents of east Lincolnshire, providing a range of services including GP services, dental services, community pharmacy services and community nursing services.
I requested today's important debate as it has been announced that, across Lincolnshire, approximately 300 health service jobs are under threat, and five wards may be closed—one at Grantham and district hospital, two at Lincoln City hospital, and two at Pilgrim hospital in Boston in my constituency. In addition, up to three surgical wards will become day-case or short-stay wards. These proposals are understandably causing significant angst both in my constituency and elsewhere in Lincolnshire.
The Lincolnshire health service is already struggling to cope, and I fear, along with many people working within Lincolnshire's NHS, that these cutbacks would have a profound effect on the provision of local health care available to my constituents and the other people who reside in Lincolnshire. Staff at Pilgrim and Skegness hospitals, as well as health care workers and professionals across the county, are working tirelessly to provide the best possible service under challenging circumstances and conditions, and I would like to take this opportunity formally to thank them for all their hard work. Unfortunately, health care professionals and local residents across Lincolnshire fear that the provision of health care will suffer if jobs are lost and hospital wards are to close.
The exponential growth of Lincolnshire's population has put great strains on public services such as the NHS. From 1991 to 2001 Lincolnshire's population increased by 10 per cent. compared with the national average of 2.7 per cent. This is a significant—and, I believe, unrecognised—increase. The figure includes not only people retiring to Lincolnshire from the midlands, as they have done traditionally, but those moving to Lincolnshire from the south of England to take advantage of the significantly disparate house prices. The problems facing Lincolnshire's national health service are different from those in many other areas. Our county covers a comparably large and predominantly rural area, we have no motorways, and our public transport system is limited.
As well as a growing population, we have an ageing population. Some 22 per cent. of the population of east Lincolnshire is over 65, compared with 16 per cent. of the total UK population. Additionally, there is a considerable seasonal influx of tourists to the east Lincolnshire coast. There are significant pockets of socio-economic deprivation and a transient population who often work in the low-wage, low-skill agricultural and seaside economic sectors. All those factors mean that our community is heavily reliant on the local NHS sector, but the Government have failed to recognise Lincolnshire's specific needs and have thus underfunded the primary care trust and hospital trust, which has resulted in the situation that we face today.
Those factors have put added pressures and strains on Lincolnshire's national health service, but the service has received inadequate funding from central Government to maintain and expand its facilities. As a result, the NHS in Lincolnshire reported an £8.1 million deficit for 2004–05 and faces a £20 million shortfall in 2005–06. The United Lincolnshire hospitals trust and the East Lincolnshire PCT have considered ways of balancing their budgets and eliminating the shortfall, but have unfortunately concluded that they have no alternative but to make cutbacks to front-line services. I warned the House in a debate on
During the 2004–05 financial year, the East Lincolnshire primary care trust had a specific shortfall of £4.5 million against an estimated revenue allocation level below the national average of £12 million a year. Finally—at last—the Government have recognised their consistently inadequate and unfair funding of Lincolnshire's primary care trusts and recently announced significant increases from April 2006. East Lincolnshire PCT will receive an increase of 13.6 per cent. in 2006–07 and of 12.4 per cent. in 2007–08. The requisite figures for the West Lincolnshire primary care trust are 9.5 per cent. and 10.5 per cent., and the figures for the Lincolnshire South West Teaching primary care trust are 9.1 per cent. and 10.3 per cent. Although that additional money is welcome, it will arrive too late to stop the cuts that are being talked about at the moment. I shall come back to what I believe should be done later.
It is important to put on record the interrelationship between primary care trusts and hospital trusts, because the underfunding of Lincolnshire's PCTs has a severe knock-on impact. The primary trusts have allegedly failed to fund adequately out-of-hours and GP services, so patients go to hospitals directly, unnecessarily, or via inappropriate referrals. As there is little provision to transfer patients out into the community, significant numbers of people are occupying surgical and medical beds. At Pilgrim hospital in Boston alone, 10 per cent. of the beds are occupied by people who should and could be in the community, rather than in acute beds. That happens for a variety of reasons, such as delayed discharges and because people are waiting for intermediate care, waiting to go to other, already full, hospitals or waiting for rehabilitation in the community. I accept and support the fact that there is an urgent necessity to increase community care facilities, such as emergency care practitioners and specialist nurses, and for investment in intermediary care facilities. Such facilities are not there today.
I cannot fathom how closing five wards throughout Lincolnshire, including two in Pilgrim hospital in my constituency, which amounts to 58 beds, will improve the situation. It is inexplicable. Indeed, a recent hospital trust press release highlights an existing significant shortage of beds that puts pressure on A and E services. It says:
"much of the pressure experienced in A & E is due to emergency admission patients waiting for beds".
The beds are not there.
In addition, there are concerns about the out-of-hours service across the country, and Lincolnshire is no exception. Although I recognise that the scheme may allow doctors to spend more time in their surgeries rather than driving long distances in the evening and the early morning, there are fears that the out-of-hours new practice is undermining GPs' contracts and contacts with the community.
Some GPs in Lincolnshire fear that the new system may even be dangerous, putting patients' health and safety at risk as a result of inadequate funding allocated to the new scheme. Only last month, the independent Healthcare Commission was asked to look into East Lincolnshire PCT's out-of-hours service, following specific GP criticism. Once initial inquiries are completed, the commission will decide whether it needs to press ahead with a formal investigation. I await, as my constituents do, its decision with interest.
I have one final issue to tackle—the new consultant contract. Sold as a plan to improve service provision by rewarding consultants fairly for all activities undertaken, it was poorly resourced from the outset. Indeed, it has achieved the inverse of the original objective. There is now a drive to curtail consultant activity down to a base level to save money by reducing consultant pay. That is inevitably having a detrimental impact on patient care and was a significant contributory factor to the shortfall within the United Lincolnshire hospitals trust. It is incredible that the Department of Health, as well as the strategic health authority, failed to foresee the problem.
In conclusion, will the Minister assess the viability of allowing the primary care trust to draw down money from next year to fund the wards at Pilgrim hospital as intermediate care wards so that no beds are lost, so that there is no diminution of service for my constituents and other Lincolnshire residents who use Pilgrim hospital, and so that the primary care trust has a facility within Pilgrim hospital to take the patients out of acute and medical wards? That would free them up and ensure that there is no impact on other essential services in Pilgrim and other hospitals across Lincolnshire.
The Government of course blame the funding shortfalls on those working in the NHS. Will the Minister therefore explain why, if, as the Secretary of State stated on the "Today" programme, the funding shortfalls are all a mistake of the managers in the NHS, there have been no resignations by those responsible for the mismanagement? I am not talking just about Lincolnshire, because the problem is becoming prevalent in hospital trusts across the country.
The proposals to cut services and jobs in Lincolnshire's NHS are of significant concern not just to those who use the NHS, but to those who work in it. They will have a detrimental impact on health care provision and a negative impact on morale, and will exacerbate recruitment problems, which the Minister will realise are already serious in much of Lincolnshire. As a result of bed shortages, it may put routine and regular surgery at risk without community care facilities in place first. The Government were warned, but they failed to act in time to stop those cuts. The people in Lincolnshire now hope that they can take action to stop the ward closures and the talked-about job cuts.
I sincerely congratulate Mark Simmonds on securing the debate and providing such a thorough analysis. He takes a keen interest in health issues in Boston and Skegness, and on
I hope that the hon. Gentleman will indulge me as I briefly sketch out the backdrop to the debate. We are halfway through a 10-year plan to transform the NHS, turning it from the creaking service that we inherited in 1997 into a well resourced, patient-centred service that is fit for purpose in the 21st century. We are therefore introducing national standards, which, over time, will set out the entitlement to health care for residents, including the constituents of the hon. Member for Boston and Skegness. Those standards are backed by a tripling of health investment to £90 billion a year in the next few years. The changes are already delivering record falls in deaths from coronary heart disease and from cancer, and in the number of suicides. I pay tribute to the staff throughout the national health service for their work in securing those achievements.
The hon. Gentleman was concerned about the risk to services. I noticed in the Lincolnshire papers that I perused in preparation for tonight's debate some of the changes that are taking place in Lincolnshire and Lincoln. I was delighted to read of the outstanding performance of the accident and emergency department at United Lincolnshire Hospitals NHS Trust, which the hon. Gentleman mentioned. That department consistently sees 97 per cent. of A and E patients within four hours, which is a far cry from the days when people had to take a sleeping bag to A and E. Its performance is so good that it was awarded a special performance bonus of £100,000. I was delighted to read of the opening at Lincoln county hospital of £4.25 million-worth of specialist wards for elderly care and of a new stroke unit, which was opened by the Princess Royal. I was impressed by an innovative new scheme—the first in the country—devised by Lincolnshire Ambulance and Health Transport Service NHS Trust designed to alert the A and E department of patient details before the patient arrives. All those innovations were made possible by new investment.
The purpose of tonight's debate, however, is to discuss not what has been achieved so far but what needs to be better. At the heart of our deliberations this evening is the question of money. Lincolnshire is a beautiful county, and the hon. Gentleman's constituency is a beautiful place. I am a great fan of its church architecture in particular. The delivery of health care in Lincolnshire carries challenges which, while not unique, are rare. First, there is the demographic challenge, to which the hon. Gentleman alerted the House, particularly in the east Lincolnshire coastal area. Between 1999 and 2004, population growth peaked at 25 per cent. in the 57-year-old age group. As the hon. Gentleman mentioned, postcode analysis demonstrates that the majority of those people were relocating to east Lincolnshire from the former industrial areas of Nottingham, Leicestershire and south Yorkshire, with associated high levels of long-term conditions and health needs, which are reflected in mortality figures that are higher than those for the indigenous population. The rural nature of the county is also a factor. The cost of provider services in Lincolnshire partly reflects the complexities of delivering health services to a dispersed population. For example, the United Lincolnshire Hospitals NHS Trust runs five A and E departments, which serve a population of about 640,000 people with over an hour's drive time between individual sites.
To remedy that problem, the Government have introduced a new system of funding for local health care, which first creates a baseline of what local need looks like and, secondly, sets out a plan for increasing funding in different places to meet that baseline. That involves significant change for the hon. Gentleman's primary care trust, and I am grateful that he has recognised that. From 2003–04 to 2005–06, there is an increase of about £67 million, and in the next couple of years, there will be an increase of £87.5 million, making a total of £154 million by 2007–08. That should go a considerable way towards allaying concerns about change. That £154 million boost is not under-recognition, and it will have a major impact on our ability to finance innovations such as the new contract for consultants. We have always made it clear, however, that where there is new investment there must be reform. Central to reform in Lincolnshire is action to tackle the deficits in local health budgets, and I think that the hon. Gentleman made an excellent job of laying those out to the House. I would go slightly further and say that if no further action is taken and there is no reform ahead, the local health community forecasts that overspending this year will rise to about £13 million by the end of March 2006.
I am glad to hear that the reform required to accompany the extra £154 million investment now appears to be in hand. Central to that is ensuring that best practice in the rest of the country arrives in the hon. Gentleman's constituency. It is clear, and it is accepted by local management, that the NHS in Lincolnshire has not moved far enough or fast enough in modernising service delivery. While there are pockets of excellent practice, too many services are still provided along a traditional model. In particular, far too many patients are transported and admitted to hospital, and once there they spend too long in an acute care setting.
Change in practice needs to be considered carefully, but the achievements to date should provide some measure of comfort. The hon. Gentleman said that the changes proposed were inexplicable, so I shall try to shed a little light on them. Over the past year, for example, United Lincolnshire Hospitals Trust has improved patient pathways across primary care, acute care and social services, enabling the average length of stay to be reduced from 7.9 days in 2003–04 to just 6.7 days in 2004–05. That is an 18 per cent. improvement in just a couple of years, which has allowed the trust to reduce its overall bed stock by 110 or 8.8 per cent. to 1,141 across all sites.
Crucially, that has been achieved without reducing the levels of service provision or activity at any of the sites operated by the trust. In fact, quite the opposite—over the same period the local health community succeeded in reducing the maximum in-patient waiting time not for one specialty, but for all specialties, including orthopaedics, to six months by April 2005, significantly ahead of the national target, which was December 2005.
Over the next year, 2005–06, the combined effect of a 5 per cent. reduction in emergency admissions, equivalent to seven patients per day across the whole of Lincolnshire, and a continued reduction in the length of stay to an average of 5.5 days, which is national best practice, will enable a further 143 beds to become free. Let me be clear: the reduction in bed numbers will not reduce local people's access to health services. If there are ward closures, they will be general wards and will therefore not result in the closure of any local specialties.
I want to go slightly further tonight and reassure the hon. Gentleman that reducing surplus beds does not form part of any current plans to reconfigure the status of individual sites. The only services that will be moving this year from Boston Pilgrim to Lincoln County are those being centralised in order to comply with guidance from the National Institute for Health and Clinical Excellence, particularly in respect of "Improving Outcomes" guidance for cancer services.
The response to the challenges that the hon. Gentleman sketched out are measures rooted in local consultation. The direction of travel, I understand, for local health service redesign in Lincolnshire was set out in two key local health community documents. The first was the Lincolnshire acute services strategy, which was developed and formally consulted on during the summer of 2003. Local community stakeholders, including expert patients, were involved in preparing the proposals. Consultation with patients was undertaken in the Boston locality to help develop the plans.
Secondly, all six NHS organisations in Lincolnshire, together with the county council, have developed a 10-year Lincolnshire health and social care strategic framework. That sets out the acute services strategy in a wider context and has been endorsed by all the trust boards. It was formally signed off in March 2005 by the Lincolnshire health and social care partnership board, which includes a cabinet member from Lincolnshire county council.
Beyond that, the path to balance is set out in the new community-wide financial recovery plan developed in partnership with the county council, among others. Change, of course, is difficult, but ultimately every community must decide what shape its local health service needs to take in order to deliver the standards that are set out nationally. There is a measure of cross-party consensus on this. It was Mr. Lansley who recently thundered to an audience that
"we will stop trying to run the day-to-day health service from the desks of Whitehall".
I agree with him up to this point: that the NHS should not be micro-managed from Whitehall. The role of Health Ministers and the Department of Health is to secure adequate resources and to set out a strategic framework for the NHS to work within. It is right and proper that the decisions on prioritisation are taken locally, and we have put decision making where it needs to be—in the hands of the local NHS.
The quid pro quo, however, is that if we are to run services locally there must be local engagement and consultation. I understand that that is now happening. First, the local health community is working collectively and with partners to finalise the NHS financial recovery plan. Following a presentation of the emerging proposals to the Lincolnshire health and social care overview and scrutiny committee yesterday, a revised submission will be made to the SHA on
In summary, this is about the delivery of local services. We have increased funding for primary care trusts very significantly. It is now for PCTs to decide on their local priorities. All NHS organisations—I am sure that the hon. Gentleman would not demur from this ambition—must live within the resources that they are allocated. Although that may mean some service change, the overall direction of travel is towards investment in improving the NHS locally and nationally. That is changing the health and well-being of people in this country, including the hon. Gentleman's constituents.
Question put and agreed to.
Adjourned accordingly at twenty-one minutes past Eight o'clock.