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I beg to move,
That this House
notes the current financial crisis and associated job losses, ward and bed closures and service reductions in the NHS;
believes that these are consequences primarily of the failures of management at the Department of Health;
further notes the Secretary of State for Health's denial of responsibility for this situation and her failure to recognise the realities within the NHS;
sees a lack of leadership within the Department of Health;
and, in addition to turnaround teams in NHS Trusts, calls on the Government to appoint a turnaround team to the Department of Health.
With all the difficulties that the Government have experienced, it is good to see, in the first line of their amendment, that they still have a sense of humour. I welcome new Ministers to the Department of Health. I bid farewell, although I do not think that they are present, to Jane Kennedy and Mr. Byrne, who have gone in different directions. Although we have not agreed on policies, we have always enjoyed good personal relations. I thank them for the tasks that they performed at the Department of Health.
I welcome the Minister of State, Department of Health, Andy Burnham and the Under-Secretary of State for Health, Mr. Lewis to their posts, but I warn them that it is not a happy ship. The Secretary of State has lost the confidence of hard-working NHS staff. She and her team have lost the trust of the British people to manage the NHS effectively. The public want value for money, and they want an NHS that is given the freedom and responsibility to deliver quality services for them. Instead, the Secretary of State and her team have created confusion, instability and inefficiency. The Government, by the same measure that they apply to NHS trusts, are failing. The time has come for them to put a turnaround team into the Department of Health, just as they have imposed such teams on NHS trusts. That is the purpose of the motion.
In May last year, when the Secretary of State took up her job, she said that she would listen to patients and staff. She visited five hospitals in five weeks, and then for eight months failed to visit any hospital outside London at all. Is it any wonder that she lives on a different planet from the staff of the NHS? When she says that it is the best year ever for the NHS, they say, "Has she any idea of what's going on?" [Hon. Members: "Who says that?"] The NHS staff say that. They have said it loud and clear.
NHS staff know that patients who could be treated sooner are waiting nearly six months before having their operations. They know that patients are waiting many months for diagnostic tests. They know that waits for audiology tests and for curative radiotherapy have lengthened. They know that hospital infections are as bad as ever; that the obsession with targets has cost millions and distorted patient care; that there are fewer district nurses and health visitors to deliver care closer to home; that despite that, beds are being closed, job vacancies frozen and jobs cut in local hospitals; that newly trained nurses and physiotherapists cannot find jobs; that the number of managers has doubled while financial management remains poor; that key new screening programmes are being delayed; that public health targets are being missed; that health inequalities are widening; and that there is utter confusion over further NHS reorganisation.
The simple answer is yes, as far as patients are concerned. Can the hon. Gentleman tell us, though, what patient satisfaction ratios say about the situation in the NHS that he is describing?
Every year, the NHS should improve. Every year, the NHS receives high satisfaction ratings from patients who are treated by NHS staff. That is precisely the point. NHS staff know that millions of patients are indeed receiving excellent care and treatment. They know that new treatments and new ways of working can do much more for patients. They know, for example—the Government mention it in their amendment—that the use of statins and stents can reduce the number of deaths from coronary heart disease.
I will tell the hon. Gentleman this before I give way to him: NHS staff know that, far too often their achievements are in spite of Government interference, not because of it. They are angry when the Secretary of State claims credit for their successes, while presiding over an incompetent administration without which NHS staff would be free to achieve so much more.
The hon. Gentleman tells us that the NHS should improve every year, and I agree with him. Can he tell me how long a patient in whom a GP diagnosed suspected cancer would have had to wait to see a consultant specialist in 1997, compared to the maximum of two weeks for which such a patient would have to wait now?
I can certainly tell the hon. Gentleman what the Government think. The Secretary of State has reported to the Cabinet that she expects to miss her cancer waiting targets. I can tell the hon. Gentleman— [Interruption.] If he cares to listen, I will tell him. The waiting time for curative radiotherapy has lengthened under this Government. [Interruption.] Radiotherapy is a cancer treatment. This is what happens with Government targets: instead of targeting the whole patient experience, the Government target only the time before the first treatment. Subsequent treatment is not targeted at all.
The way in which, for years, the Government targeted urgent referrals—the Secretary of State knows this, even if the Prime Minister did not—caused immense damage in distinguishing between urgent and routine referrals. Dr. Stoate, for all his knowledge of the NHS, fails to note that—deliberately or otherwise—whenever he talks about the two-week period of referral to a consultant.
Do not the interventions from Labour Members demonstrate that they, and the Government, are living in a parallel universe? There is more bad news to come. Next week, the Oxford Radcliffe Hospitals NHS Trust will have to announce the number of frozen jobs and job losses that will be necessary to offset £33 million of enforced cuts. People in Oxfordshire are really angry. When they look at the Government's website they see that the trust is one of the best-performing, most cost-effective trusts in the NHS, and they cannot understand why more jobs must be lost.
If the Government are arguing that the job losses and deficits throughout the country that are having to be compensated for are simply the result of poor local management, let them look at the audit reports of the County Durham and Darlington NHS Trust, in the Prime Minister's own constituency. They show that it has a good management that is working hard to deliver, but the Government's mismanagement of NHS finances has caused it serious problems.
I want to make it clear to the House that this is not just a recent problem; there has been a catalogue of failures under the Secretary of State's stewardship. In July, the NHS chief executive sent out instructions for strategic health authority and primary care trust reconfiguration, which, he said, were in line with the Government's policy of separating commissioning from the provider role. By November, however, the Secretary of State was apologising for that and making it completely unclear whether PCTs would be provider bodies.
The Secretary of State dealt with that issue, and as a result of discussions, considerable changes were made. I recently had a mammogram, and although I would normally be quite calm about it, I was very scared because one of my staff had recently been diagnosed with breast cancer. However, within two weeks she was in hospital, having the operation that she needed. She is also diabetic, and the treatment that she received was impeccable: the hospital ensured that the treatments for her diabetes and for her breast cancer were in harmony. Does the hon. Gentleman accept that although there are occasional failings, many people are getting far better treatment than they used to get? In any system, there will be—
Thank you, Mr. Speaker. I do not live in a parallel universe. In the world that I live in, NHS staff deliver excellent care to the great majority of patients, but they also work in hospitals that are experiencing job losses. In the world that I live in, the consequences of deficits are getting worse, and although urgent referrals for cancer treatment are being seen within two weeks, some people are waiting much too long. The Government do not even measure the wait for many diagnostic tests; however, the information that they are just starting to gather shows that people are waiting six months or longer for basic diagnostic tests.
I am grateful to the hon. Gentleman for giving way at this point. He talks about NHS funding, but can he tell us who would benefit most from his own rule of providing funding only from the proceeds of growth: patients or staff? Has he made it clear to the country that that would mean cuts for the NHS?
When the hon. Lady understands that parties in all parts of the House are talking about future increases in resources for the NHS, and that the Chancellor of the Exchequer is in no way certain about what NHS resources will look like beyond 2008, we can have that debate. She does not know how much this Labour Government plan to spend beyond 2008. All that I know is that between now and 2008, the Government will have to deal with the immense deficits that are cutting back the resources available to front-line services. That is a consequence of mismanagement.
I thank my hon. Friend for that intervention, which illustrates a lesson that the Government need to learn. The map of deficits throughout the NHS shows that three years ago six strategic health authorities were in deficit; that two years ago the figure was seven; that a year ago the figure was 12; and that last year the figure was 21. The Secretary of State told the Health Committee that this problem was confined to the healthiest and wealthiest parts of the country, but it is not; it is a systemic problem right across the country.
I will give way in a moment, but first I want to make some progress.
In July the Secretary of State said that the 2003-04 NHS deficit would be £140 million. Weeks later, the then NHS chief executive said that it was in fact £250 million. In August the Secretary of State had to reveal that the key health inequalities of life expectancy and infant mortality—both targeted by the Government—had widened. In September thousands of doctors were found by the BMA to be unable to find training posts. Junior doctors see training budgets being cut and a future severe shortage in the training posts available to them to fulfil their vocation.
In October the Secretary of State said that primary care trusts should not refuse to provide Herceptin for early-stage breast cancer. By February her Department was telling the High Court that Swindon primary care trust's refusal to do so was not incompatible with Government policy. Also in October, the Secretary of State told the House that there was enough flu vaccine, but by November it emerged that she had confused UK-wide supplies with the at-risk groups in England only. On avian flu, she promised the House that she would have contracts with suppliers for items such as face masks and gloves. Those contracts have not yet been tendered for.
In November, when we had a debate on the subject of NHS deficits, the Secretary of State told the House that the Government would reduce the NHS deficit this year compared with last year. We told the House that despite unprecedented resources, the trusts were in deficit to the tune of £600 million last year—2004-05—and predicted deficits approaching £1 billion for 2005-06.
It is worth bearing in mind the fact that the hon. Gentleman and his party have voted against extra money for the NHS on every occasion. Is it a fact that the general deficit for the NHS for the year just gone was around 1 per cent., and in 1996-97 it was 1.5 per cent.? Deficits under this Government have been lower than under the Tories.
It is a fact that in the year of the 1997 general election NHS bodies started spending money virtually without constraint, in the expectation that a Labour Government would bail them out. My right hon. Friend Mr. Dorrell might recall that. The hon. Gentleman is also right to say that the deficit for the year just gone probably will be about 1 per cent. of NHS resources. However, the NHS is a body that is voted a certain sum of money by Parliament, and for it to spend more than that is serious. In my book, several hundred million pounds is very serious.
It is also true that between 1997 and 2002 there were no system-wide deficits in the NHS, but hospital trusts in England finished the year before last with an accumulated deficit of some £300 million. They finished 2004-05 with a deficit of some £600 million, and they will have finished the last financial year with a deficit of some £1.1 billion. The hon. Gentleman and many other Labour Members will be wondering why strategic health authorities are cutting a third of their additional allocation to primary care trusts this year to hold the sum as a reserve. It is because they need some £1.5 billion this financial year to bail out the accumulated deficits and the underlying deficits that hospitals are experiencing.
The situation is worse than my hon. Friend has told the House, because hospitals have to find a further £1.5 billion for the 2 per cent. efficiency savings, taking the black hole in the NHS to more than £3 billion. Is it not inevitable that many more hospitals and jobs will be lost in the NHS?
My hon. Friend will understand that I do not accept that the requirement for NHS trusts to deliver efficiency savings is a black hole. If they are asked, albeit rather arbitrarily, to increase efficiency savings from 1.7 per cent. for the previous year to 2.5 per cent. this year, that constitutes an effort to try to deliver greater efficiency, although it has not been accompanied by any measures to help it to happen. What many staff of NHS trusts object to is that the tariff is being manipulated at the same time, so that last year they had a 7.1 per cent. uplift for pay, prices and costs, and a 5.3 per cent. increase in tariff. This year they will have a 6.5 per cent. uplift for pay, prices and costs but only a 1.5 per cent. increase in tariff. That is why hospitals in many parts of the country find that they have no alternative. Their PCTs will not send them any more patients, and say that there is a limited financial envelope for their activity. The tariff being paid does not reflect the costs that the Government have imposed.
The present NHS deficits are a major issue, but senior members of my hospital in Shrewsbury came to see me as early as autumn 2004 to tell me that they were facing huge deficits in the future. They were told to keep quiet because a general election was in the offing and the Government did not want the matter raised.
I visited that hospital with my hon. Friend and can vouch for the fact that those problems were emerging at that time, but we do not need to speculate about how the Government were trying to cover things up in the run-up to the election. The present Secretary of State for Work and Pensions was a health Minister before that election, and in March 2005 he said, "Don't worry about it. At this time of year they're always predicting deficits and it always turns out all right." After the election, the red ink was all over the books.
Does my hon. Friend agree that the PCTs' deficits have been made much worse by the ham-fisted and badly negotiated central contracts with professionals, which have had unforeseen consequences for the amount of money involved? If the Government had negotiated a better deal for the professionals and the taxpayer, we would not have so much of a problem.
I am very interested that my right hon. Friend should raise that point, as I want to deal with what happened in respect of pay and contracts in December. When the pay review bodies reported, the Prime Minister said that he was proud to be paying NHS staff more, but Labour Members will recall that the Secretary of State met those bodies in December. Although the Department of Health had stated in September that it accepted a pay rise of 2.5 per cent. for NHS staff, she wanted the pay increases for nurses and doctors to be reduced to 2 per cent. and 1 per cent., respectively.
Interestingly, the pay review bodies rejected the Secretary of State's argument. They said:
"We do not believe that the assimilation costs of recently negotiated pay modernisation should be taken into account in setting the level of the basic uplift for future years. These costs were part of the negotiated agreement and should have been taken into account during the negotiations rather than clawed back at a later date".
In other words, the pay review bodies were saying, "Don't come to us asking us to cut future pay settlements because you got the figures on your contracts wrong." The cost of the contracts miscalculation is now £600 million.
In a moment. Moreover, I can tell the House that the King's Fund is to produce a report on the consultants contract tomorrow. It will conclude that
"a combination of rushed implementation, a serious underestimate of existing consultant workloads and a lack of national guidance has made it difficult for hospitals to use the contract to bring about improvements for patients".
I want to return to what the hon. Gentleman said about payment by results— [ Interruption. ] I have been trying to intervene for some time on that point. I heard his criticism of the Government's scheme, but does his party support the introduction of a national tariff? If not, what changes would it make?
I have always made it clear that we support payment by results and a national tariff, but the hon. Lady asks an interesting question. In the three months leading up to the end of the last financial year, the tariff could have been amended in a way that would have assisted the NHS dramatically. In December last year, some hospitals had capacity. However, the PCTs that were running out of money told hospitals to delay treating patients until the end of the six-month waiting time, with the result that operating theatres and staff sat idle. Why could not the national tariff be amended to allow hospitals and their local PCTs to agree marginal pricing arrangements? When we debated the 2003 legislation in Committee, we argued for such flexibility, as my right hon. Friend Sir George Young will confirm, but Mr. Hutton and the Government resisted it. We asked whether, if a hospital could offer marginal capacity at a marginal price, the NHS should be able to buy it. The answer was "No". That is ridiculous and damaging, but that was the Government's policy.
By the new year, the Secretary of State had blocked Barts and the London's private finance initiative bid. The net result was a 20 per cent. reduction in the number of beds and £35 million wasted on the delay.
A few minutes ago, the hon. Gentleman said that hospital trusts had overspent in the hope that a Labour Government would bail them out—a statement that Hansard will record. Should Governments bail out a hospital trust that overspends?
And Bassetlaw went Conservative. The answer to the hon. Gentleman's question is no. Ministers know that because I have written an article in the Health Service Journal on precisely that point. There should be a change in Government policy. If a hospital restores itself to recurrent financial balance, with prospective financial stability, and can meet the authorisation criteria to become a foundation hospital, the Government should be prepared to turn past deficits into public dividend capital for a new foundation hospital. That is not a bail-out—the interest still has to be paid on the PDC.
The Government are preparing to do the opposite of their own policy, however. Their policy is not to bail out hospitals—I have heard the Secretary of State say it—so why are they creating a £1.5 billion strategic health authority reserve? What is its purpose? It is for a bail-out. There will be the most enormous bail-out this year and it will transfer the problems of deficits from one set of trusts to every trust.
Only last week, Louis Appleby, the national director for mental health, said that mental health trusts the length of the country were cutting services not because they were in deficit but because other trusts were in deficit. A mental health trust in my constituency has to make savings of £2.5 million this year, not because it is in deficit, but because its PCT is. The national director said that was a disgrace, and he is right.
Bailing a hospital out is one thing, but adding injury to that is another thing altogether. Is my hon. Friend aware that Queen Elizabeth hospital in my constituency is in a recovery plan? It has built up a large deficit. Staff are working hard to pull it around, yet the Government have imposed a 10 per cent. usage charge, which will add £1 million to the problem. Is not that wrong in principle?
Yes. If hospitals were genuinely free and given the opportunity to behave in a businesslike way, they would be able to make different arrangements for their financing needs. Indeed, some PCTs are doing just that; things are getting so desperate in the NHS that a PCT in my constituency has borrowed £2.5 million from the local authority. However, I must make progress because we have only reached the new year.
In January, the Secretary of State's operating framework for 2006-07 said that new guidance on PFI would be published, with the effect of cutting the PFI programme by a third. The guidance never appeared and it is reported that it has gone into limbo, and nobody with a PFI project in prospect knows what will happen. The same document stated that in this financial year
"for the system as a whole we expect to recover any overspend from 2005/6 and we are planning for a surplus."
It said that individual NHS bodies should plan both to achieve in-year balance and recover 2005-06 deficits.
"All organisations are overspending to show improvement during 2006-7, and by the end of the year everyone should have monthly income covering monthly expenditure."
What kind of financial balance is that? It happens to coincide with the 12th month of the financial year. The Government's policy has completely changed. They did not tell the House about it; it emerged from a letter written to me. The policy is no longer to achieve financial balance in 2006-07—it may not even be to do so in 2007-08. We simply do not know what is the Government's policy to restore NHS finances.
No, I have given way.
In January, the White Paper proposed a new gimmick for the NHS. Hon. Members will remember that the Secretary of State said that we would all have German-style polyclinics. The problem is that we have a third fewer doctors than Germany has. Germany does not have our system of GPs. We do not have community specialists to anything like the extent Germany has them. The Secretary of State's self-styled vision of care closer to home will not work if health visitor numbers are down 2 per cent. on 1997 and if the number of district nurses is down by 14 per cent. compared with 1997. Of course, despite her U-turn on community hospitals, the NHS has not listened to her. Community hospitals are still being closed, because of PCT deficits. Hospitals are being subject to cuts on the assumption that patients will be treated closer to home, yet the community hospitals, intermediate beds and community nursing staff required to do exactly that are being cut as well.
My hon. Friend is aware that, only today, a hospital that he visited two years ago—the Fraser Day hospital in Newport Pagnell—has been announced for closure. That is a desperate blow for the city of Milton Keynes, whose people are reliant on the hospital for intermediate care. Does he understand my constituents' concern that we have an ever-expanding city in Milton Keynes but an ever-shrinking health care service?
I recall visiting the Fraser Day hospital. For a growing city, with a capacity-constrained hospital, the importance of the intermediate care facilities in the community or the support that could be given to patients who are discharged is terribly important. The Secretary of State is always talking about preventing readmission to hospital and reducing the length of bed stay. That cannot happen while the services that my hon. Friend describes are being shut down. It is a disgrace.
By February, things had got worse. The home oxygen service collapsed on
She did . [ Interruption. ]
It became clear in February and March, too, that the Government's legislative programme had collapsed. The new Leader of the House is here, and I welcome him to his post. I am sure that he will be interested to know that the Department of Health was given the benefit of three measures in this legislative programme, but the policy on the Health Bill collapsed and the Government had to do a U-turn, the NHS Redress Bill has been radically changed in the Lords from the Government's original proposals and the draft Mental Health Bill has been abandoned. We simply do not know when the Government's new and, I hope, better proposals will arrive.
In March, the trauma got worse. Deficits turned to disasters. On
The hon. Gentleman does not yet know how many hospital trusts had deficits last year. Certainly, more PCTs had deficits last year than the year before. It might be true that more hospitals had deficits last year than the year before, and more might do so this year. As I made clear earlier, we have gone from six to seven to 12 to 21 strategic health authorities that, in the total health economy, have a deficit. We are not talking about an isolated instance. If those deficits were being disguised in the past by brokerage from surpluses elsewhere, there would not now be a system-wide deficit—there would still be surpluses to offset the deficits. The point is that very few such surpluses are being created to mask such deficits. The Government will have to create surpluses by the expedient of cutting money from primary care trusts, which will cause a great number of problems in the hon. Gentleman's constituency.
In April, there was the issue of dentistry. On
I am grateful to my hon. Friend. The truth is that there are Labour Members who know that, all across the country, such consultations have too often been a sham. It is a disgrace that the public have been deluded into believing that NHS organisations are genuinely listening to them, whereas in fact those organisations are being dictated to by the Department of Health.
The Government promised that every single patient referral from a GP would be booked through the choose and book system by the end of December 2005. The latest figure, in April 2006, is about 10 per cent. On electronic prescribing, the Government's target was for 50 per cent. of prescriptions to be electronically filled by December 2005. In February 2006, the figure was 1.8 per cent. Confidence in the NHS IT programme continues to fall. The latest disclosure is that an NHS care records service, which was intended to be up and running in 2005, has been put back—no date is now offered—and will have to be piloted. People who know about such programmes have said that user involvement and piloting the systems would have been the right way to proceed in the first place.
If there are Members from Scotland and Wales present, they will understand that the NHS care records service in the Government's connecting for health programme is not currently compatible in relation to England, Scotland and Wales. That will be fun at the Countess of Chester hospital and the Royal Shrewsbury hospital.
I agree that all too often the NHS does not listen to the public in consultations. In my own area, in the case of Epsom and St. Helier University Hospitals NHS Trust, it took the Secretary of State to take account of local people—rather than the health bodies—and to agree that the critical care hospital was to be at St. Helier.
The question of whether the Secretary of State acted wisely or even reasonably in relation to that matter will be tested soon. We will come back to that question in due course.
I am afraid that we arrived at the point in April when the latest statistics added insult to injury for NHS staff. The work force census showed that the number of managers had doubled since 1997. In the last year for which the figures were gathered, the number of administrators went up by 11,000—while the number of nurses went up by 6,000. That is in the teeth of all the Government's claims to want to cut the bureaucracy of the NHS. That is not happening at all. On the basis of all that, on
The Prime Minister has retained the services of the Secretary of State at the Department of Health, apparently to push forward NHS reforms. If the Prime Minister believes that, he is living in the parallel universe that the Secretary of State inhabits. Conservative Members believe that reform is essential, but that even more so is leadership and competence. The Government's combination of arrogance and incompetence is a recipe for disaster.
Every aspect of desirable reform is being undermined by the actions of Health Ministers. Patients should have choice, but PCTs, through referral management centres, are controlling and subverting choice. Patients need a voice, but after scrapping community health councils, the Government are going to abandon patients forums and have no idea what to put in their place. GPs need real GP budgets, but the Government's plans do not offer them the incentives to reinvest their savings or give them the power to negotiate contracts with providers. The Government talk about local decision making, but that is being abandoned because the SHAs are top-slicing PCT budgets and controlling the growth money for the NHS for this year.
Progress towards foundation hospitals is being delayed and their freedoms are still severely limited. National standards need to be set through the National Institute for Health and Clinical Excellence, but the guidelines are not being implemented and the postcode lottery goes on. The independent and voluntary sectors have no clarity on their future involvement in the NHS. The second wave contracts are being scaled back, and the wave 1 contracts cost 11.2 per cent. more than the NHS price. As independent sector treatment centres are guaranteed payments whether or not they do the work, they are bringing the system of independent contracting into disrepute.
One cannot talk, as the Prime Minister does, about a patient-focused service that is locally delivered when at the same time the NHS is controlled by an overbearing bureaucracy and politically dictated targets. The team at the Department of Health knows neither what NHS reforms are actually needed, nor how to deliver them. No one in the NHS can say what the destination of reform is. Who will be commissioning services in the future? Will PCTs be both commissioning and providing services? Who will set the tariff? How will financial control be enforced? Will the independent sector have a long-term commitment and the opportunity to supply services to the NHS? What happens to failing hospitals? The team does not know, and the Government will not give, or simply do not know, the answer to any of those questions.
The time has come for a turnaround and a new team at the Department of Health. Ministers should be removed from their interference in the NHS. If we cannot immediately get a new Government, let us at least have a team brought in that is empowered to deliver NHS reform and the long-term stability that the NHS so badly needs. Such reform should reflect the principles of equity, choice, competition and independence for which we have argued.
Most of all, the NHS needs leadership. Professor Halligan, who was deputy chief medical officer of the Department of Health until last year, said that the NHS has
"a leadership void, which has caused it to lose its way".
He describes the service as "rudderless". Tellingly, he adds that it is
"extraordinary, the gap between highly motivated frontline staff and the systematic dysfunctionality in which they operate".
At the risk of using an unparliamentary expression, the situation is what the Health Service Journal describes as a "total cock-up". Only days ago, the outgoing director of human resources at the Department of Health, Andrew Foster, who is one of the most senior NHS officials, said:
"It's been almost tangible over the last 15 months, the growing sense of dislocation between the NHS and the Department of Health and a growing lack of confidence in the leadership of the Department".
Even those working most closely with the Secretary of State express their lack of confidence. NHS staff did so in loud and clear terms. We have no confidence in her stewardship of the Department. It is time for a turnaround. It is time for Conservative policies and, frankly, it ought to be time for a Conservative Government who are committed to a NHS that is energised and equipped to deliver. It is time for change, and I commend the motion to the House.
I beg to move, to leave out from "House" to the end of the Question, and to add instead thereof:
"recognises the effective leadership given by the Department of Health in managing the NHS;
acknowledges that the majority of NHS organisations are living within their budget and providing patients with better services;
welcomes the turnaround in the NHS since 1997 as a result of the dedication and commitment of staff, backed by the Government's programme of investment and reform;
congratulates the Government for trebling investment in the NHS by 2008 compared with 1997;
welcomes the recruitment of more than 300,000 extra staff in the NHS since 1997 including 85,000 more nurses;
notes that waiting lists are now at their lowest since records began with over 370,000 fewer patients waiting for an operation than in March 1997;
further welcomes the fact that all patients can now expect to wait no longer than six months for their operation and that 98 per cent. of patients are now seen, treated or admitted within four hours in accident and emergency departments;
and applauds the NHS for saving more lives than ever before. Including 43,000 more people saved from cancer and 87,000 saved from coronary heart disease."
I am delighted to start by welcoming to their posts the Minister of State, Department of Health, my hon. Friend Andy Burnham, on his promotion, I congratulate him and the Under-Secretary of State for Health, my hon. Friend Mr. Lewis. I take the opportunity to thank my right hon. Friend Jane Kennedy for the work that she has done, especially in securing the new private finance initiative for Barts, the Royal London, St. Helens and the new private finance initiative building programme for Birmingham. I congratulate the new Minister for Policing, Security and Community Safety, my hon. Friend Mr. Byrne, on his promotion to the Home Office.
Mr. Lansley spent the past 40 minutes telling us about everything that he thinks he is wrong with the national health service. A year ago, he was telling people that he believed in the patients' passport—taking money out of the NHS to put into private care. He says now that he has changed his mind and that he really believes in the NHS. Four years ago, he voted against more money for the NHS. Now he and his right hon. and hon. Friends keep demanding more money for the NHS. He and his right hon. Friend Mr. Cameron have turned round their positions so often that the public no longer know what the Conservative party believes in.
Let me tell the hon. Member for South Cambridgeshire what we have done about turnaround in the NHS. In 1996, I have one cutting from one day. It reads:
"22 patients spend the night on trolleys. A&E unit closes its doors. Patients diverted to Queen Mary's in Roehampton which is earmarked for closure".
That was under the Conservative Government. In 2006, no patients were waiting on trolleys for hours on end. There was a maximum wait in accident and emergency of just four hours. That is a turnaround. It is a target that the Conservative party said could never be met and should never be set. It is another example of what the Conservative party describes as Government interference. However, it is a target that NHS staff—more of them than ever before—are delivering. There is a new hospital to be built at Queen Mary's in addition to 81 new hospitals since 1997, and there are many more to come.
The title of the debate relates to management of the NHS. Does the Secretary of State agree that promises given by the Government should be fulfilled? One was that when hospitals merged, their debts would be wiped out. Ministers in the right hon. Lady's Department have confirmed that that is the case. However, when Shrewsbury merged with Telford the existing £3 million debt was not wiped out and was instead brought forward. Will the right hon. Lady look into that, because it is causing terrible problems for my hospital?
The hon. Gentleman and I have discussed that matter before. He needs to accept, as do other hon. Members, that these so-called historic deficits are simply previous years of overspending. All too often, that overspending has been matched by underspending in far poorer parts of the country. The hon. Gentleman must face the fact that if a deficit is to be wiped out in one organisation, the money must come from somewhere else.
The right hon. Lady knows that the Surrey and Sussex trust has suffered the most disgraceful political interference and has not been allowed to manage its own affairs. The deficit has been about £10 million a year to keep Crawley hospital open as a full functioning hospital. Her Department approved the reform plans put forward by the trust, but then placed a moratorium upon them. It is to be hoped that the local managers will be given the opportunity to manage. There have been five years of political interference in the interests of the Labour party. This is an absolute disgrace, and the right hon. Lady should apologise.
No doubt the hon. Gentleman would like to tell the House and the people of Crawley that his proposal is to close all facilities at Crawley hospital and sell it off for luxury housing or something else. I believe, and the people of Crawley believe, that there should be a community hospital in Crawley. That is exactly the plan that the local primary care trust is working on.
No, I will not. I wish that Mr. Blunt had acknowledged that in the East Surrey PCT, where more than 600 people used to wait more than 13 weeks for their first out-patient appointment, there are no patients now waiting for such an appointment. There used to be more than 500 people—in fact, there were once more than 1,000 people—waiting more than six months for an operation, but now no one waits for an operation for more than six months. That is turnaround.
I wish to make progress.
We know very well how much more there is to do, because we created the NHS in the teeth of Conservative opposition, and we believe in it. We know, too, that we need investment and renewal to meet the growing needs of an ageing population, to exploit all advances in medical knowledge, to match the scale of rising expectation, and to match our ambitions for the health service. That is why we made the difficult decision to ask people to pay higher contributions to fund record investment in the NHS—money that the Opposition voted against.
On higher contributions, two patients with early-stage breast cancer in the Royal Shrewsbury hospital receive Herceptin. That treatment is funded by the British taxpayer, but those patients have paid taxes all their lives and I wish them luck. Someone with early-stage breast cancer who has a Shropshire address must find £47,000 on top of all the taxes that they and their family have paid throughout their life, or they face the prospect of dying. Will the Secretary of State meet some of those ladies? I wrote to her three times in the past month, but she would not reply. Thanks to the prompting of the previous Leader of the House and a written question, I received a reply from the Minister of State, Department of Health, Ms Winterton, but she did not answer the question. Will the Secretary of State meet those ladies?
The hon. Gentleman knows that treatment for women with breast cancer is faster and better than it was under the Opposition. He knows very well—he should know—that death rates from breast cancer have fallen faster in this country than in almost every other country. He knows, too, that as Herceptin has not been licensed or evaluated for treatment of early-stage breast cancer, those difficult decisions must be made by the local NHS. However, we have speeded up evaluation by the National Institute for Health and Clinical Excellence and independent experts—not by Ministers—to ensure that treatments for NHS patients are available everywhere.
One of the right hon. Lady's reforms could be very helpful, as it proposes to use more private treatment centres offering specialist services to provide high-quality fast treatment. How far will that extend, and how many treatments will there be in, for example, two years' time?
As the right hon. Gentleman knows very well, we have indeed used independent sector treatment centres, just as we have used spare capacity in the private sector to ensure that NHS patients receive the fastest possible care, all of it free at the point of need. The ISTC programme will continue, and I estimate that when we complete wave 2, about 10 per cent. of elective treatments will be carried out in the independent sector, all of that free at the point of need.
On a point of order, Mr. Deputy Speaker. The Secretary of State will know that when a petition is presented to Parliament it is usual for the Government Department and the Minister responsible to reply. I presented a petition on the loss of thousands of jobs in Staffordshire, but I did not receive a reply. I have presented thousands of letters to the Minister—
Order. I suspect that that is a point of debate disguised as a point of order, however skilfully, or otherwise. The hon. Gentleman should seek an opportunity to catch my eye so that he can make his point in a different way, and not as a point of order.
We are making record investment in the NHS, above all in our staff. We have 330,000 more NHS staff than we had in 1997. We have 85,000 more nurses, 10,500 more consultants and more than 32,000 more doctors and hospital dentists. We have more staff delivering faster and better care for more patients than ever before.
But renewing the NHS after nearly 20 years of underfunding and neglect by the Conservatives was never going to be easy. That is why I want to tackle head on the financial difficulties that have arisen. The majority of hospitals and primary care trusts are improving patient care, hitting the targets that we have set, and employing more staff and paying them better than ever before, which the hon. Member for South Cambridgeshire seems to oppose, and they are doing all that within their budget.
In an Adjournment debate on the Floor of the House on
I will write directly to the hon. Gentleman on that matter.
Although a majority of NHS organisations are making all the improvements I have outlined within their increased budget, a minority are overspending, and some very seriously. Because of that, in the financial year just ended, the NHS as a whole will have overspent by around 1 per cent. of its total budget. That cannot continue, particularly in the 7 per cent.—just 7 per cent., or about 40 organisations—that account for more than 50 per cent. of the deficit.
The Hertfordshire Partnership NHS Trust, which deals with mental health, has never been in deficit since 2001. It provides an excellent service and has never overspent, yet this year it has been asked to cut its budget by £5.2 million. Can the Secretary of State tell me why it is being asked to cut its budget, when it has always operated within its financial parameters?
I shall come to that point in a little more detail in a moment.
The problem with the minority of organisations that are overspending, including many across Bedfordshire and Hertfordshire, is that those problems have an impact on other parts of the NHS, including the mental health trust to which the hon. Gentleman refers, which have been living within their budget.
Of course, restoring the NHS to financial balance entails difficult decisions. Nobody wants redundancies, and every hospital and primary care trust will do everything that it can to avoid making a staff member, particularly a front-line clinical member of staff, redundant. Behind almost every story on redundancies, every scare-mongering headline and every figure that the hon. Member for South Cambridgeshire uses—he did it again this afternoon—is a hospital that is sensibly cutting back on temporary staff from expensive private agencies, like West Hertfordshire Hospitals Trust. It has a deficit of £28 million and an agency bill of £17 million, and it is going to get that down.
The Secretary of State speaks of temporary staff not being replaced. What about permanent staff who are leaving and not being replaced in the various institutions?
The hon. Gentleman must decide whether he wants hospitals to become more efficient and effective, and whether he wants more day case surgery, more patients looked after in the community and more emergency admissions avoided, or will he stand in the way of change and progress, and refuse to support hospitals making difficult but right decisions?
If it is all about agency staff, will the right hon. Lady explain why, over the last two years, the proportion of the NHS pay bill spent on agency staff has declined at the same time as the deficits have ballooned? If it is all about treating patients closer to home, why are intermediate care beds being closed and why are there fewer district nurses and health visitors? Why are these objectives—they are not new to the Secretary of State, as they started with Frank Dobson in 1998—not being fulfilled?
Of course spending on agency staff has started to go down, but it has not gone down enough. Does the hon. Gentleman really think that the Barking, Havering and Redbridge hospital, for example, should not reduce its £34 million bill for temporary and agency staff? Does he really think that the Royal Free hospital, which he mentioned, should not reduce its agency bill or reorganise its wards and the use of its permanent staff to give patients more effective care with better value for money?
Let me provide another example. South Tees hospitals trust has already reduced staff by 300 as it has become more effective, and with just three compulsory redundancies. While it did so, the number of people waiting more than six months for treatment fell from more than 470 to zero. Sandwell and West Birmingham hospitals trust has already cut its costs by £10 million, the equivalent of 200 jobs, but with only one compulsory redundancy. The number of people waiting more than six months for treatment in that trust fell from 23 to zero.
The right hon. Lady seems to be portraying the whole of the deficit problem as if it were the fault of the hospitals. My constituency has one of the most efficient hospitals in the country and, if it were paid at the full tariff, it would be in surplus. It is in substantial deficit, even though it was viewed as the third best hospital in the country and the best in the south-east last year. Indeed, it has been in the top 40 hospitals in every one of the last six years. It is the only hospital in the country to achieve such a record, but guess what is happening? It is being cut back sharply, so what possible logic can there be in any system of health delivery that does that to such a successful institution?
We expect every hospital, right across the NHS, to go on becoming more effective and efficient and to go on using all the extraordinary advances in medical technology that enable them to do so. In each area of the country that receives fair funding for its population we expect the NHS to deliver the best possible care for all patients—outside as well as within hospitals—within their allocated budgets.
What I am suggesting, as is confirmed by virtually every hospital chief executive and clinical director to whom I have spoken, is that as more day-case surgery is done, patients can be treated better and faster with fewer acute beds and therefore fewer staff in certain jobs. That is not worse care for patients, but better care for patients and better value for money.
I am somewhat surprised to see the Opposition in today's debate blocking the reform that is so badly needed. Opposition Members used to talk in the past about the reforms that needed to be made to secure value for money. My right hon. Friend has pointed out some very good examples of where change has taken place with minimum disruption. It is important to assure people working in the NHS about their futures and their ability to deliver the best possible service to our population. Will my right hon. Friend share her information with all trusts, so that those experiencing change can do the best they possibly can with it?
My hon. Friend is right. That is exactly what we are doing through the Modernisation Agency and the NHS institute for improvement. As staff change jobs, and particularly as more services move from hospitals and into the community, we need to support those staff, particularly where they need to change their skills.
Let me give the House an example of exactly how the NHS is making those changes in Dudley, where I recently met several of its patients. One is Ron Lane, a gentleman in his 70s who has severe heart disease. He told me that his community nurse now gives him tests and treatment in a couple of hours in his own home that just two years ago used to require an emergency admission and several days in hospital. He told me that his quality of life has been transformed thanks to those community nurses. In just 12 months, thanks to the NHS community nurses in Dudley, 120 patients like Mr. Lane have had more than 500 fewer admissions to hospital.
The new acute hospital in Dudley has fewer beds than the old hospital. It needs fewer staff in many of those jobs, and the local NHS is underspending on its hospital budget, so it has more money to put into other improvements for other patients, which provides better care for patients and better value for money. The reforms that we are making, which the hon. Member for South Cambridgeshire has said that he supports but has also attacked, and the changes that we are making, with stronger commissioning from GP practices and primary care trusts, will give every part of the NHS the incentive to do what Dudley and many other places are already doing.
Given what the Secretary of State has just said about the importance of shifting services towards the community, will she take this opportunity to clear up a major policy mix-up for which her Department is responsible? Last July, she announced that it was her policy for PCTs to divest themselves of responsibility for service delivery. Is that still her policy?
I made it absolutely clear to the House last autumn and again in the White Paper that primary care trusts, as well as having a stronger commissioning role, will continue to employ staff in the community and to provide services. That is a matter for them and for their patients and users, and there is no requirement for them to divest.
I can confirm that the Secretary of State gave me that answer on
My hon. Friend is absolutely right. When we reviewed the funding formula a couple of years ago, we found that some of the poorest areas in the country with the worst health problems were anything up to 20 per cent. below their target funding, while other healthier and wealthier areas were between 15 and 25 per cent. above their target funding, and we are changing that situation. In the old NHS, over-spending in one place was simply compensated for by underspending elsewhere. As my hon. Friend said, that was not only unfair, but utterly ineffective, because overspending areas had no incentive to put their houses in order. Our changes and reforms have not created those problems, they have revealed them, and now they are helping to correct them.
I am grateful to the Secretary of State for giving way; as my hon. Friend has indicated, I have just arrived from Northern Ireland. Will the Secretary of State indicate the lessons that she has learned following her reception at a recent meeting by angry nurses and union staff, who say that the NHS is in a mess? This is the third term of new Labour, so can they all be wrong?
I will make a little progress, if I may.
The point about fair funding is absolutely central. Because we have promised to give people in every part of the country the best possible care, we are reforming the way in which the NHS is run so that every hospital takes responsibility for organising the best care within its budget. We will not expect others to bail them out.
I repeat the promise that I made to the House—by next April, the NHS as a whole will be back in financial balance. That is why we have asked the strategic health authorities in each region to work with primary care trusts to create a financial reserve so that the organisations in deficit, particularly those with the biggest deficits—that small minority—can be supported while they make the necessary changes.
I want to thank the leaders and staff of the primary care trusts and strategic health authorities who are making very difficult decisions. I particularly thank all those organisations that have already done so much to improve services, have done it within their budgets and are now having to postpone some of the further improvements that they want to make for their patients in order to help solve problems elsewhere.
I stress to the House—as I have said to the strategic health authorities—that, unlike under the old system, every area that is contributing to the new reserves will get its money back, normally within the three-year funding period, and that, wherever possible, the areas of greatest need to which my hon. Friend Tom Levitt referred will get their money back first.
While many of us would agree with some of the health reforms that the Government are proposing, particularly as regards delivering health care in the local community, how is it that they are bringing back cuts in the district general hospital in my constituency, the Princess Royal, while at the same time cutting back on the very community hospitals through which they are suggesting that they want to deliver their reforms?
On community hospitals, I made it very clear in the White Paper in January that any local NHS that was proposing to cut or close a cottage hospital or community hospital should look again at that decision in the light of strategy to get more services not only into community hospitals but into people's own homes. I am glad to say that those changes have already been made in some parts of the country.
The right hon. Lady says that she called on local primary care trusts to turn around any decisions that they may have taken locally to close community hospitals for purely financial reasons. Will she have a particular word with the Kennet and North Wiltshire PCT, which is consulting on closing seven community hospitals? Its chief executive has said that she is determined to close them, despite what the Secretary of State says, because she is the Margaret Thatcher of the national health service, and the lady is not for turning.
As the hon. Gentleman knows full well, every part of the NHS that is proposing such changes has to consult its local patients and users and to seek the approval of the strategic health authority. We have already promised a new generation of at least 50 community hospitals, because some existing cottage hospitals are not providing the right services, are not in the right buildings, and will need to change.
The hon. Gentleman is misinformed—I chose my role.
The Secretary of State may have noticed that the loudest voices in the debate—I recall the intervention of Tony Baldry—are from places where overspending has occurred in the NHS. The consequences for communities such as my constituency are that important services for my constituents, such as their mental health services, are being seriously affected to deal with the imbalance in the funding in the strategic health authority. Yet the voices that are noisiest in the Chamber, and often noisiest in the community, are those of privilege. What will my right hon. Friend do in future to protect those whose health is poorest? [Interruption.]
My hon. Friend makes an enormously important point. We are prepared to ask only the organisations that are in balance or even surplus to— [Interruption.]
My hon. Friend made the point that her primary care trust has had to postpone improvements in services that her constituents desperately need to help sort out overspending in other parts of the country. It is precisely because those postponements can only be temporary that I am insisting that the organisations in areas that have been overspending must make the decisions necessary to sort themselves out. I will not take complaints about that from Conservative Members who troop in to see me and stand up, week after week, in Prime Minister's questions and Health questions to demand more money for their services, patients and hospitals when they voted against the record investment that we are already making.
We have written a very big cheque for the NHS. Conservative Members voted against it. However, it is not a blank cheque—it never has been and never will be. Conservative Members delude themselves and try to delude the public when they pretend that there is a limitless amount of money, that overspenders can be bailed out without any difficult decisions and that no part of the NHS should be expected to become more efficient.
Conservative Members say that they want more efficiency and more services in the community but they refuse to back the local NHS and local hospital trusts that are making difficult decisions to release resources for other improvements. They voted against increases in taxation to invest in the NHS, and they demand cuts in funding today. It simply does not add up, like the rest of their policies.
The changes that we are making in the NHS are true to its founding values. It is funded by taxation and free at the point of use. Care is based on what people need, not on what they can afford to pay. There must be fair funding to tackle health inequalities in the poorest parts of the country. Only by continuing to change and improve the NHS will we keep those values relevant in times that are changing faster than ever.
Every health care system in every developed country faces the same challenges of rising public expectations, an ageing population and extraordinary advances in medical science. I believe that the NHS—the fairest health service of them all—will meet those challenges better than any other health service in the world as long as we have a Labour Government. Only a Labour Government who believe in the values of the NHS and do not blow hot and cold about them can combine the courage to make the huge investment needed—
Order. The solution is not to raise a point of order. There are other parliamentary means of pursuing those matters, which are matters of debate, however strong the feelings on both sides.
I entirely recognise that Mr. Paterson feels strongly about that matter, but I am not prepared to take lectures on the NHS from the Conservatives, or from the hon. Gentleman, who keeps demanding more money for new treatments—more money is, indeed, needed for new treatments—but will not support the investment that we are making or the difficult decisions needed to get all the NHS to the levels of effectiveness necessary to deliver the best care for patients with the best value for money. Only a Labour Government who believe in the values of the NHS will combine the courage to make the huge investment that the NHS needs with the courage to make the tough decisions to see the job through.
I should also like to begin by welcoming the Minister of State, Department of Health, Andy Burnham and the Under-Secretary of State for Health, Mr. Lewis to their new ministerial roles. I congratulate them on their appointments. On the theme of turnarounds, it has been interesting to watch the Secretary of State turning around from being a Blairite to a Brownite in the course of her speech. She used the code word "renewal" twice, so we now know that, after the Government have been in office for nine years, the key need for the health service is renewal. We heard it here first.
It is my pleasure to kick off our contribution to this debate as the health spokesman for the party that is most trusted by the British public on the health service. What a discerning group the British public are! We understand why the Conservatives, who tabled this motion, are still not the most trusted party on the NHS. I recall being elected to Parliament in 1997, and having constituents coming to see me with letters saying that they would have to wait 104 weeks to see a consultant and to get on to the waiting list.
We owe it to the House to avoid the rewriting of history that can occur on occasions such as these. When I was elected as an MP, partly because of the Conservatives' record on the health service, people were waiting two years to get on to waiting lists, and we must not forget that. We must not allow the British public to be deceived into thinking that the Conservatives are committed to the health service and that, if only they were in power, the health service would be sorted. So much progress has been made. Indeed, if it were only a matter of the Conservatives' record on what was happening nine or 10 years ago, we might be tempted to think that the leopard had changed its spots. However, they have form not only in government but in opposition.
The hon. Gentleman has referred to the fact that it has been almost 10 years since the Conservatives were in office. Flat-lining in the polls as they are, if the Liberal Democrats want to be a real Opposition, they need to focus on joining us in holding the Government to account. It is the patients, the most vulnerable, and the poorest and weakest in our society who are being let down by the Government today.
It is interesting that the Conservatives want immediately to get the focus off where they stand on these issues. I have here a copy of the letter sent by the leader of the Conservative party to his colleagues. In summary, it says, "They don't trust us on the NHS; we'd better do something about it. Let's join leagues of friends. Let's have some Opposition day debates. Let's do some visits. Let's try to deal with the terrible reputation we have on the NHS." Well, that will not wash— [ Interruption.] I am asked whether the Conservatives are just faking it. Why did the shadow Secretary of State for Health vote against an £8 billion rise in national insurance for the national health service— [ Interruption.] I am told that that would have been the wrong way to raise the money, but I was not aware of an alternative £8 billion tax increase being proposed. Perhaps the Conservatives had secret stealth tax plans. Who knows?
When that announcement was made by the Chancellor, the then Secretary of State for Health, Mr. Milburn, said breathlessly that he and his officials had worked tirelessly overnight, over pizza and takeaway curry, to decide how to spend it. Does the hon. Gentleman agree that the money was given a little prematurely, because most of it has been wasted?
The Conservative party has form in opposition, not just on voting against the £8 billion. In the past 12 months, every Conservative Member has been elected on a pledge to take taxpayer's money to buy people's way out of the NHS. That is the Tory instinct. Rather than being the salvation of the NHS, as we heard in the speech of Mr. Lansley, the reality is that the Tories believe that if a public service does not work, the few should be helped to buy their way out of it. That was in the manifesto on which every Conservative Member stood at the general election.
I am still a new boy and learning the technique. Does the hon. Gentleman agree that it would be the height of hypocrisy for Conservative Members to shed crocodile tears for the local NHS if they do not use it themselves and are covered by private medical insurance schemes?
My view, although I have no private medical insurance, is that we have always had a mixed health economy, with the NHS predominant, which I profoundly support. There has always been a role for the private sector, to which I do not object. My concern is the way in which the Government have provided for that.
The Liberal Democrats supported the additional £8 billion investment in the NHS. There has been a growth in the number of front-line doctors and nurses, but on the Government's figures, without counting all sorts of obscure people as administrators, the growth in the number of managers over the past 10 years has been twice as fast. That is a statement of fact, and that is where things have gone wrong. It is not that those managers are doing nothing all day; they are running around chasing Government targets, monitoring and form-filling, which they should not have to do, and that is the problem.
When challenged about bureaucracy, the Government say, "We're going to sweep away managers and merge primary care trusts, which will result in less bureaucracy." I have been contacted from West Sussex, where one new primary trust will replace five. A non-executive director of one of those PCTs has written a letter saying that the new plans have
"produced an organisational structure that creates an additional layer of management."
That is the new streamlined NHS. Instead of having a health authority, a primary care trust and the doctors, it will now have a health authority, a primary care trust and eight local practice-based commissioning areas. Each of those eight—there were only five before—will have a business director and support staff for finance and commissioning, public health partnerships, primary care development, patient and public involvement and so on. Incredibly, an extra tier is being introduced, which is typical of this Government. A whole raft of new bureaucracy is being introduced in the name of efficiency. It is classic new Labour reform.
The hon. Gentleman makes an interesting point about the commissioning process. But does he prefer practice-based commissioning, which would surely cost even more?
I am slightly baffled by that intervention. I was under the impression that practice-based commissioning was Government policy, but perhaps I have misunderstood.
Many of the reforms are not inherently bad; the idea that the NHS should know what its costs are seems entirely good. However, the reforms have not been co-ordinated, planned, phased and staged; they have come helter-skelter, all at once, and have not been effectively implemented. One example of that is the failed implementation of the new tariff for children's specialist services, about which, it is reported, the former Minister of State, Jane Kennedy, resigned, although I do not know whether that is the case, and I am happy to be corrected. We have raised the issue of specialist children's hospitals, such as Alder Hey, Great Ormond Street and others, which are saying that the amount of money that they get for doing the clever things that they do for sick children is not sufficient to meet their costs.
My right hon. Friend Jane Kennedy did not decide to leave the Government because of Alder Hey. It was a completely separate issue, to do with the independent appointments to NHS posts. On the subject of Alder Hey and specialist children's hospitals, however, let me make something absolutely clear. More work is needed on the specialist tariffs, and we are doing that work in conjunction with the children's hospitals; but the top-up to the tariff that we give those hospitals has been increased. Last year it was 53 per cent. over and above the normal tariff, and this year the figure will be 69 per cent. We shall go on working with Alder Hey and the other outstanding children's hospitals to ensure that their essential work continues.
I shall be delighted if that proves to be the case, but the letter issued by Alder Hey and others only weeks ago suggested that there were multi-million-pound deficits because of the inadequacy of the tariff. The situation is extraordinary; the new tariff is being introduced very rapidly, people are not having time to adjust to it, and there is a threat to valuable front-line services. What is worrying, and what angers people about the Secretary of State, is that she appears to be out of touch with what is going on.
My hon. Friend, who is relatively local to Alder Hey, has raised an important point. What we need are long-term efficiency strategies, long-term reform and structured change. What we are getting are emergency cuts packages, and that is not a rational way in which to run the health service.
The Secretary of State talked about job cuts, implying that they involved just a few agency staff; and who would not want to cut agency staff? I recently received a letter from a young woman in Stoke-on-Trent; well, a relatively young woman. She writes
"I work at the University Hospital of North Staffs... After nearly eighteen years of loyal service... it seems according to the Government's 'turn around' team that my services are no longer needed... we as a Trust have worked really hard to meet all the Government's targets... we are being rewarded with job losses and cuts to patient care".
That is just one example, but it is disingenuous to say that this is all about agency staff. It is not solely about them. Clearly things can change, but we are talking about permanent and front-line staff. We are talking about doctors and nurses. This is having an impact not just on services but on morale. As the Secretary of State herself knows from experience, we need good will and good morale above all in the NHS. So much runs on that basis, and the Government are systematically undermining it.
The hon. Gentleman has referred to specialist children's hospitals. May I give an example that falls into a slightly different category? Does the hon. Gentleman not agree that it is truly a national scandal that the Royal Free Hampstead NHS Trust is proposing to close a centre of excellence in the form of the Nuffield speech and language unit, whose total expenditure accounts for only 0.1 per cent. of the trust's expenditure last year? The closure could take place in 10 weeks. I do hope that the Secretary of State is aware of that, and will do something about it.
I am aware of the centre to which the hon. Gentleman has referred. An early-day motion has been tabled in its support, to which I added my name recently because I share the hon. Gentleman's concern.
Is it just a bit of waste and inefficiency that is being eliminated, or is it front-line services? I received a letter from a psychoanalytical psychotherapist—also from Stoke-on-Trent—who says that the local PCT is saying this:
"less vital work... elective operations, help with hearing and eyesight... orthopaedic care, health promotion and some mental health care will be given a lower priority because of the need to protect life or death care".
Of course we want to protect "life or death care", but this does not mean just stripping out a few agency nurses; it means cutting a raft of services that constitute the bread and butter of the NHS.
Does the hon. Gentleman agree that mental health services may suffer worst as a consequence of the Government's so-called reconfiguration of health services? That means that more people will be wandering around our communities who should be receiving day-to-day care and should perhaps be looked after in the community, but who should certainly not be abandoned with no support and no treatment as a result of the Government's reforms.
The hon. Gentleman is right to highlight the fact that in several parts of the country, mental health services have borne the brunt of the problem, even though, in many cases, those services were actually in financial balance and were feeling the knock-on effect of other areas. It is often very vulnerable people and their carers who are suffering.
I am glad that my hon. Friend shares my concern about the effect of such a policy on mental health services. Does he agree that in some areas, the emphasis on targets is badly affecting the funding of preventive work on smoking and obesity?
I am grateful to my hon. Friend for making that pertinent point, which is at the heart of my argument. None of us is saying that the health service is perfect, that nothing should change and that no job, once created, should ever go, but we are saying that change should be measured, rational, planned and undertaken according to a long-term strategy. The preventive work to which my hon. Friend referred—smoking cessation and work on childhood obesity—tends to have a long-term payback. It is the first thing to be cut, therefore, because it provides no immediate, tangible benefit.
If the hon. Gentleman will forgive me, I will not give way to him again.
My concern is that so many of the cuts that we hear about are part of emergency cuts packages. When the Secretary of State says that in many cases, these problems have existed for decades and are only now coming to light, she is right, but the answer to solving decades-old problems is not to try to solve them in weeks. The point is not that nothing should ever be changed, but that the Government are trying to make changes at breakneck speed because someone somewhere is in a hurry for a legacy.
The Government consistently blame local health services for overspending and inefficiency, yet general practitioner costs, consultants' costs, the tariff and practically all the targets are centrally determined. However, if the numbers do not add up at the end, the fault, apparently, lies at a local level. How can we square that argument? The Government cannot work this one out; what is their responsibility and what is not? If a community hospital closes, it is a local decision; if one opens, it is Government policy. Which is it? They need to decide.
The Government initially allocated £2.3 billion for the "connecting for health" project, but by their own admission, they are likely to spend £6.2 billion on it. Indeed, experts project that the figure could be as high as £30 billion. Given NHS deficits of some £600 to £800 million and the impact on my constituents of the potential closure of the coronary care unit at Westmoreland general hospital, does my hon. Friend agree that there is a juxtaposition to be made between what are relatively small deficits and vast Government overspending on administrative projects?
My hon. Friend makes an important point. When a centrally imposed cost falls locally and upsets the financial balance, the cause of the problem is somehow deemed to be local mismanagement. There is a story to be told about the Government's information technology projects in general and the NHS project in particular, to which we will doubtless return.
Another key issue that has arisen in this debate is waiting. With the best will in the world, I caution the Secretary of State against talking about the Government's abolishing waiting, because if she does so she will cause real distress and anger. On
"By the end of 2008, we will effectively have abolished hospital waiting lists."
With the greatest of respect, she should think carefully before she repeats that phrase. In many areas of the health service, that assertion is at total variance with people's experience, and if she goes on making it, she will make herself look a fool.
I sometimes think that the Government are more interested in spin doctors than real doctors. Last November, the Prime Minister promised that nobody would wait more than six months for an in-patient operation. However, the number waiting for such an operation has been growing month by month.
The Government mean something very specific when they use that phrase; however, some people are having to wait much longer than the Government are saying. For example, a lady who came to see me on Friday was told that she will have to wait three and a half years for fertility treatment. Now the Government will say that that does not count, because they are not talking about that sort of waiting list. But if they keep saying that they are getting rid of waiting in the NHS and thousands of people are waiting long times for treatment of different sorts, they will not be believed, and it will really undermine what credibility they have left. So I urge them to pull back from that.
I acknowledge that pressure on audiology services is causing problems with waiting times for hearing aids, but we should put the hon. Gentleman's remarks into context. Will he acknowledge that the investment in digital hearing aids has been good, the investment in hearing testing for newborn babies has been an excellent innovation and the extra demand that has been caused by the popularity of digital hearing aids is partly responsible for the stress on audiology services?
The hon. Gentleman cannot have it both ways. I do welcome the extra investment in digital hearing aids, but if people have to wait longer because of induced demand, the Secretary of State cannot claim that the Government are abolishing waiting in the NHS.
A case of what waiting is doing to people was drawn to my attention only this week. A consultant at Guy's and St Thomas' hospital wrote to a lady—who sent a copy of the letter to me—about a genetic blood test for breast cancer. The consultant wrote:
"You remember that testing your blood within the NHS will take somewhere between 6-9 months".
The Government's motion states that they welcome
"the fact that all patients can now expect to wait no longer than six months for their operation".
However, they will not get that far if they have to wait six to nine months for the blood test. The consultant concludes, ominously, that that
"will be too late to help you make a treatment decision for your suspected breast cancer. Another possibility is that you pay £1,800.00 to send your blood sample to the US to a private company...which will deliver a result within 4-6 weeks."
That is the NHS in which the Government have nearly abolished waiting.
The hon. Gentleman raises an important point about the confusion over waiting lists. There is a huge gap between the Secretary of State and the general public. The Government say that waiting lists are falling, but they are not talking about the sort of issues that constituents come to see me about. Does the hon. Gentleman agree that there is a huge problem not only with waiting lists, but with people being refused tests or treatment? Constituents have been told by the hospital that they need procedures such as PET scans or other tests for Parkinson's, but that the PCT is not funding them at present. Those people are not waiting, but they are being denied treatment that they need.
The hon. Lady raises the important issue of what the NHS does and does not do, which is separate from the issue of waiting. If some people cannot get treatment at all, it is another facet of that problem.
We should also talk about what needs to be done. I listened in vain for nearly 45 minutes to the hon. Member for South Cambridgeshire for any suggestions, and there is nothing in his motion about what needs to be done. A constructive and effective Opposition say what needs to be done, so I shall point out several measures that need to be taken.
The first is that if one accepts the Government's logic, the NHS should be given greater time to adjust. If one believes in a market directed by incentives—including incentives to be more efficient—it needs time to adjust. Incentives do not work over night. If the NHS is to be restructured, new units built and old ones closed, the effect will take time to be felt. The logic of the Government's position is that we should not have wholesale reform all at once to be implemented quickly. Instead, change should be phased, staged and managed, but that is not what is happening. One cannot sort out the problems of decades in weeks.
The second key aspect is the need, at the very least, for the infamous level playing field between the NHS and the private sector. All too often, the independent treatment centres, which are supposed to be the dynamic, free-market, capitalist competition that will ensure efficiency, are being subsidised and given guaranteed business. That is the exact opposite of what should happen. For example, a doctor wrote to me recently saying:
"One contributing factor"— to the problems of the NHS—
"is the...Treatment Centre...in Shepton, which is treating straightforward patients for routine ops at an inflated tariff and leaving the more complex cases, as well as sorting out their errors, to the local NHS."
He makes an interesting point when he states that the number of staff working there is very similar to the number of redundancies at the Royal United hospital, Bath. He says that that is no surprise, as those staff members are doing the work that the RUH has lost, although at a higher price. That cannot be a rational way to manage efficiency in the health service.
The shadow Secretary of State, the hon. Member for South Cambridgeshire, asked about what should happen when a district general hospital "loses business", as the jargon has it. He did not answer his own question, but the logic of the Government's policy is clear, and it is that district general hospitals may close when their work can be taken up by regional specialisms, treatment centres and GP surgeries. However, have the Government talked to the British public about that? Has there been a debate about whether we think that district general hospitals have a future?
The answer to both questions is no. We have had no such debate. What is missing most of all from the NHS is real local democratic accountability. The NHS employs 1.3 million people, or one voter in 35. The only person democratically accountable to all those people is the Secretary of State, who has just left the Chamber.
I shall give the House an example from my own part of the world. In the former area of Avon, none of the local MPs and councillors, regardless of party, wanted the PCT configuration, but the health authority just said, "Tough." Where is the democracy and accountability in that?
That is not merely a constitutional point. We want the NHS to be genuinely accountable and answerable to us not just because we pay for it, but because that would be more efficient. Local people and those whom they elect would be able to scrutinise what went on and ask pertinent questions. At present, they are completely shut out; only one person is accountable for the NHS, and she takes no responsibility for it.
Over the past nine years, the amount of money going into the NHS has risen from historically low levels to something more credible, but the problem has been the endless interference and issuing of diktats from the centre. Local discretion has been limited, but the blame when things go wrong is always shifted to local NHS management.
That has to stop. We want real local democratic accountability, and that will mean that the NHS is different in different parts of the country. That is what local people want; they should be allowed to have it, and not be told from the centre how things are going to be.
We should not go back to the pre-1997 regime that failed the NHS. There have been real improvements since then, but we need a measured pace of reform, serious accountability and decentralisation. Running an organisation of 1.3 million from one office in Whitehall is not the way to proceed.
Order. Given the obviously large number of hon. Members who want to take part in the debate, it may be helpful to the House if I repeat that there is no time limit on speeches today. When that decision was made, there was an insufficiency of speakers, which shows what can happen with the best laid plans of mice and men.
I begin by saying how intrigued I am by the Opposition's motion today, which seeks a turnaround in the Department of Health. When I was in opposition, I sat on those Benches and demanded that the Conservative Government of the day save jobs in the NHS. Now, some Conservative Members are doing the same thing. That is the biggest turnaround in my experience of this House, although the difference is that there are now 300,000 more jobs in the health service than when they left office. [ Interruption. ] Mr. Stuart asks a question from a sedentary position, but I invite him to intervene. I am quite happy to take him on, but I see that he does not want to get up. That is okay, and I shall move on.
The Opposition motion mentions the word "turnaround", but the greatest turnaround in our NHS began in May 1997. It may have taken a couple of years to take effect, but that was when the NHS started to get the expenditure that it had needed for a long time. I have to disagree with my right hon. Friend the Secretary of State when she says that 18 years of Conservative Government took money away from the NHS; the process began in 1976 under Denis Healey when he started to attack the NHS capital expenditure programme—an easy public sector target whenever a Government come under pressure. The cuts have decades of history and the process did not end for a long time, but it has ended over recent years.
The Conservative motion suggests that the Secretary of State does not understand the realities of the NHS. I fundamentally disagree. My right hon. Friend knows fine well what the realities are. Steve Webb referred to some of them when he talked of the need for staged change in the NHS. He said that the changes needed to be better timed, because things had been done in a bit of a rush. I have been hearing that in this place for 23 years. Before that I was active in local politics and I heard it there, too. Every time we ask for change in the NHS, we are told, "Yes, but don't do it now." I do not say that things could not be done better, but I suspect that the hon. Gentleman is listening to the voices of vested interests—people who work in the NHS and do not want to change. In certain circumstances, it is a great pity that they do not want to. We have all heard those vested interests in media reports over the past few weeks, and I have heavily criticised some of them.
I want to set out what has been happening in the NHS since the Government took office in 1997. We have dealt with waiting times of more than six months, although earlier we heard an example that showed they were increasing again. In March 2000, three years after we took office, more than a quarter of a million people had to wait more than six months for an operation; by December 2005 the number was almost nil. The bar on the Department of Health graph is so small that I cannot see what the number is.
In 1998-99 the mean waiting time for a cataract operation was 225 days; in 2004-05 it was 91 days—a reduction of 60 per cent. The mean waiting time for a heart operation in 1998-99 was 136 days; it is now 91 days—a reduction of 33 per cent. There has been a reduction of 19 per cent. in the waiting time for hip replacements and of 25 per cent. for the diagnosis of heart conditions. When I look at all those changes, I cannot recognise the NHS that was described earlier.
I am listening to the right hon. Gentleman with interest. Will he explain why after increased expenditure of more than 23 per cent. during the period to which he refers, the number of clinical episodes has increased by 1.6 per cent? Will he reflect on that?
National health service funding has doubled since Labour came into office in 1997, and in two years' time it will have trebled; that relates to deficits. I do not want to talk about deficits in this debate, because the Health Committee, which I chair, will be looking into how trusts can run up massive overspends after the Government have given them increased budgets year on year for at least the last six years.
In 1998-99 there were 201,000 cataract operations; in 2004 there were 306,000—a 52 per cent. increase. There was a 78 per cent. increase in heart operations over the same period, and an increase of 22 per cent. in the number of hip operations and 11 per cent. in the number of kidney transplants. The list goes on— [ Interruption. ] The hon. Member for Beverley and Holderness can sit there interrupting all day, but I am setting out facts that show what has been happening in our national health service over the past few years.
Let us look at heart disease. Waits for heart surgery are down to less than three months. In March 2000, 2,800 people had been waiting more than six months, and it was not uncommon for patients to wait up to two years. The average waiting time for heart procedures is down by a third since 1998-99.
The right hon. Gentleman is getting angry, because he wants to read out his figures. Why does he think that staff morale in the NHS is so low? Why does he think that doctors and nurses are so angry? The Government are giving us a picture that is not recognised by the staff or patients.
I will refer to the hon. Lady as my hon. Friend because she serves on the Health Committee, but I fundamentally disagree with her. She was out with the Committee going round the health service, both the independent sector and the NHS, just a few weeks ago, and I did not hear anger when I sat in rooms with nurses, some of them from the private sector—the independent sector, as it is called—and some of them from the NHS. I did not hear anger when we sat together, taking evidence for an inquiry that we are undertaking at the moment. I do not see that anger, but we get it from the top sometimes. We got it from the Royal College of Nursing, which, as I said in the media, was involved in a disgraceful attack—an attack on freedom of speech more than anything else. I remember standing on picket lines with health service workers, when there were 85,000 fewer nurses in our health service, because they were getting hammered at that time . [ Interruption. ] Mr. O'Brien is at it again—if he wants to intervene, I am quite happy for him to do so. [ Interruption. ] No, he will have his say later.
Does my right hon. Friend agree that, whatever the frustrations of health service staff, those who used the opportunity of the RCN conference to exaggerate grossly and even fabricate the evidence that they were using to try to embarrass the Government were totally out of order, and did their cause no good?
That is absolutely right. I look forward to the RCN lobby on Thursday, when I will meet at least one of my constituents.
I shall move on quickly. I was looking at heart disease. About 70,000 cardiac procedures were performed in 2004-05, which is a 59 per cent. increase in activity since 1998-99. In 2004 there were 15,300 fewer deaths from coronary heart disease than in 1997—a reduction of 35,000 since the baseline assessment of 1995-97. Cancer deaths are down by nearly 14 per cent. in the past seven years, saving about 43,000 lives. Some 600,000 additional women are being screened for breast cancer. Cancer consultants have increased by 43.7 per cent. since 1997. There are more than 1,300 more cancer consultants in this country. No one can say that cancer services have not improved massively in this country; they certainly have done.
There are over 17 per cent. more diagnostic radiographers and over 24 per cent. more therapy radiographers than there were in 1997. Since April 2000, we have had 146 new MRI scanners, 135 linear accelerators, 224 CT scanners and more than 730 items of breast-scanning equipment. I only wish that all of them were being used as much as they could be in our NHS, so that we could get waiting lists down a lot more. That is the truth of what has happened in our NHS under this Government.
My right hon. Friend is giving a fascinating insight and a comparison between what we inherited in 1997 and the improvements now, but he is comparing like with like. Is it not the case that the range of treatments available in the NHS has extended, and that the cost of some of the new treatments, certainly in the early stages, is exorbitant but necessary? Has he done any analysis in the Health Committee about the effect of that on NHS spending?
We have done so on an ad hoc basis at this stage. Let me tell the House that early-stage use of Herceptin could add £1 million to my PCT's budget for the current financial year, and it is likely that many new drugs will put pressure on budgets in years to come. By and large—not in all cases, as these are clinical decisions—budgets have been healthy enough to take up most of the cost.
I am not sure whether the right hon. Gentleman was going to deal with diabetic retinal screening services. The reality in my constituency is that last week, the manager of that service in Chase Farm hospital had to cancel interviews, on the direction of those above—no doubt because of the £31 million deficit. No doubt that will affect front-line services and those dealing with screening services. Where is the reassurance in the Health Bill about the protection of general ophthalmic services?
That is more a matter for the Minister than for me. There are many things involved. One Member—it might have been Mr. Paterson—talked about Herceptin and whether people in his constituency could get hold of it, because people in a neighbouring constituency could. I do not see many examples of patient care being affected at this stage.
I have had this debate twice in one week with the general secretary of the Royal College of Nursing and I have asked her to send me examples. I am sure that the Health Committee, which I chair, would want to look at examples if patient care is being affected—as opposed to jobs being affected in certain circumstances. There are several things involved. The general secretary of the Royal College of Nursing said on BBC radio that the safety net was being removed from under national health service patients in this country. I challenged her to give evidence of that. To date I have not found any evidence whatsoever. If it is out there, I would like to see it.
Mr. Lansley did not entirely answer the intervention made by my hon. Friend Dr. Stoate about seeing suspected cancer cases within two weeks, and the situation that existed before. More than 99 per cent. of suspected cancer cases are now seen within two weeks. That is up from 63 per cent. in 1997. Again, there has been a substantial increase. Those are the figures that the hon. Gentleman should have given.
My final point relates to my earlier intervention on the Gentleman. In my view, we should measure what is happening inside our national health service in terms of its impact on patients, not jobs. The national health service is there primarily for patients, and not as an employer. There were many times when large parts of the public sector were there to provide social employment; that is not the case any more. God knows, in my own constituency, I saw thousands of jobs go from public sector industries that were there for social employment reasons. That is how we should look at the situation now.
A MORI poll on public attitudes to our national health service draws attention to users' good personal experience of the NHS. It says that 81 per cent. of hospital users were satisfied with their last visit. In a Populus poll, 70 per cent. said that, based on their own experience, a good service was provided in the NHS. That is not anecdotal evidence. We are not talking about vested interests being shouted out in television studios or conference halls. The polls reflect the views of the people whom the NHS is there for. There is no doubt at all in my mind that in 1997 a turnaround team was put into the Department of Health, and it is working wonders for an area of the public sector that was badly neglected for many years.
I will begin by following on pretty directly from what Mr. Barron was saying. On the basis of his speech, I could couple him with the Secretary of State and ask him to reflect on why the reaction that the Secretary of State received to her statement that the NHS had just enjoyed its best year ever was as strong as it was. On the basis of his speech, he is clearly bemused by the reaction that the Secretary of State received and he prefers to believe that it was all got up by a group of Tory politicians and journalists. The right hon. Gentleman and the Secretary of State would serve their cause better if they reflected a little longer on the fact that the Secretary of State's comment received an intense reaction not just in the political world, but right through the national health service. They might serve themselves better if they set out to understand why people reacted as strongly as they did.
I made this point, in effect, in an earlier intervention. If the statement had been that patients had had a better year, nobody could have grumbled about that, because that is the case. The right hon. Gentleman was a Health Minister so he should know all about the issues inside the health service. We then come to the question of how there could be a so-called spontaneous demonstration at a conference—with hundreds of people sitting there all wearing the same protest T-shirts. The simple answer is that that was not patients being mad at the national health service; it was people who might have to move and change their jobs in the next few years. If that improves patient care, they should get on with it.
The right hon. Gentleman was kind enough to refer to the fact that I was once Secretary of State for Health. I have read briefs very similar to the speech that he just made to the House—on occasion, I have even read them to the House. They are no substitute for an honest reflection on why people react to circumstances in the way that they do. He is quite right to say—and the Secretary of State may reasonably reflect—that the national health service has been the beneficiary of record levels of expenditure. He is quite right to say that record numbers of people, in the history of the national health service, were treated last year, record numbers of clinicians were employed and records levels of resources were deployed. Given those facts, why did people dispute the proposition that it was the best year ever? I want to focus on that question, because some important policy conclusions can be drawn from the reasons people reacted in the way that they did.
Perhaps I can help the right hon. Gentleman to explain why there was such a strong reaction. As someone who worked in the health service and spent a lot of time speaking to people who use the health service and people who work there, I know that the facts are that people have much higher expectations than they had before—and so they should. People expect to have better treatment. They expect to be treated more fairly and more humanely. That is the way things should be, and long may that continue. Things are available now that were not even conceived 10 years ago. As my right hon. Friend Mr. Barron said, most people receive a far better service than they did before—albeit that the health service staff might not entirely always agree with that point.
The hon. Gentleman is quite right to say that things are being done in the health service now that were not done in 1997. It is equally true that things were being done in the health service in 1997 that were not done in 1987. That is the first point to make when thinking about why the Secretary of State was so misguided as to present her case in the way she did. In fact, in every year of its history, the national health service has used more resources, treated more patients and employed more clinicians. The proposition that everything is better this year than it was last year—or better this year than in 1997—is one that every single Secretary of State for Health from Aneurin Bevan onwards has been able to make, and justify.
As my hon. Friend Mr. Lansley said, the thing that causes offence in the national health service is the suggestion that that progress, which is the result of the efforts of individual clinicians and employees right through the service, is due to the interventions of politicians—in other words, politicians claiming credit for the endeavours of employees. My hon. Friend was entirely right to say that, in the health service today, there is a broad sense that people are making progress, as the health service has always made progress, but doing so despite the intervention of politicians, rather than because of it. That is the first point.
No, I want to make a bit more progress.
Let me move on to the second point. The argument that has not yet surfaced in the debate is that one of the reasons for low morale and demotivation in the health service, as well as one of the reasons for the major waste of resources in the health service in recent years, is the programme of constant reorganisation—the bureaucratic moving round of the deckchairs. Let me briefly recite the Government's record on the reorganisation of the service.
When Frank Dobson was appointed, he said that he would abolish the internal market, but then Mr. Milburn was appointed and said that that was wrong and that the Government would reintroduce foundation hospitals. The present Secretary of State says that the Government were wrong to abolish not only the independent management of hospitals but fundholding, so back comes practice-based commissioning with a deadline of involving every general practitioner in GP fundholding, or practice-based commissioning—they are exactly the same—by December this year.
I intervened to ask the Secretary of State about the role of PCTs in the delivery of service, because it is one of the issues on which the Government have caused deep confusion throughout the service in the past 12 months. She said, as though it was somehow clear and everyone knew it, that PCTs would go on being involved in the delivery of community-based health service care. However, that is absolutely not what Ministers have been saying over the past 12 months.
It is worth repeating Ministers' words. In July 2005, the Government's position was:
"PCTs will become patient-led and commissioning-led organisations with their role in provision reduced to a minimum."
There was confusion about that and Ministers announced an extension to the deadline, which was originally the end of 2008. When the then Health Minister, who is now Secretary of State for Work and Pensions, gave evidence to the Health Committee on
"Are you telling us that the Government is as committed as it ever was to see frontline medical staff move away from employment in Primary Care Trusts? Is that what you are telling us?"
The then Health Minister replied:
"I think we have set ourselves a long-term objective, yes, but I think what was clarified was the removal of the 2008 timetable for that."
There was thus a statement in July 2005 to say that PCTs would divest themselves of the services. By November, they were still going to do that, but do so without a deadline. However, today, the Secretary of State says that PCTs will not divest themselves of the services. It is small wonder that there is confusion in the service about where the bureaucratic deckchairs will come to rest when Ministers can give three fundamentally different answers in 12 months to a very simple question.
I hope that I can demonstrate that I do. The right hon. Gentleman has been considering the question of what is good for the NHS in terms of structures and processes, rather than patients. However, on his specific point, let me refer again to a question that I asked the Secretary of State during Health questions on
"I assure my hon. Friend that district nurses, health visitors and other staff who deliver services in the community will continue to be employed by the PCT unless and until it decides otherwise."—[ Hansard, 25 October 2005; Vol. 438, c. 152.]
Her answer came after a debate that had taken place between July and October because of uncertainties. It means that the decision is in the hands of a PCT and will not be imposed on it.
If the Secretary of State said that on
"I think we have set ourselves a long-term objective, yes, but I think what was clarified was the removal of the ... timetable".
What is the Government's policy on the subject?
Further to add to the confusion about the policy, the interim chief executive of the NHS more recently told primary care trusts that insofar as they may continue to have a provider role, they must ensure that their governance arrangements wholly separate their commissioning and provider roles. We will thus end up with not just merged PCTs, but bifurcated PCTs.
I hope that those who heard the words of the senior manager in the health service will now regard the position as clear, although I gather from my hon. Friend's tone that it is not clear to him. It is certainly not clear to me whether PCTs in the long run will, as the Secretary of State said in July and her ministerial colleague said before the Health Committee in November, ultimately be divesting themselves of provision, or whether they will remain bifurcated in the way management describes. I do not want to dwell any longer on the matter. However, I wanted to emphasise it because it is an aspect of the process of constant management change that is one of the reasons why the Secretary of State received such a reaction when she tried to suggest that the NHS had had one of its best years ever.
The thing that makes me cross is that all this is unnecessary. Of course I do not disagree with the direction of a health policy that is an attempt to put commissioning back in the hands of GPs, to give the power to manage hospitals back to hospitals and to distance the Department of Health from the day-to-day micro-management of the NHS. I could hardly disagree with that direction of policy because it was the one that we pursued when I was both a junior Health Minister and Secretary of State for Health. However, it makes me cross that nine years after the Government came to power—it has been nine years of confusion, wasted resources and demotivation—they have made a 360° U-turn. That is a major factor behind the demotivation of the staff of the NHS.
Let me move on to another reason the Secretary of State received the reaction that she did. There is emerging knowledge in the NHS that the good times are over and that there has been, to an almost criminal extent, a wasted opportunity. That is not to say to the right hon. Member for Rother Valley that no good has been done—of course good has been done—but people in the NHS understand and increasingly reflect on the scale of financial mismanagement during the growth years as they find that the years of plenty are inevitably, under Governments of any political complexion, coming to an end. The Government get credit, as they should, for the fact that they have doubled the resources going into the NHS, but they must accept responsibility for management decisions on the use of money and the consequences of those decisions as they work themselves out in the coming years, as people in the service are increasingly seeing that they will.
I will offer two examples that people working in the NHS increasingly cite when they talk to me. They talk about the employment prospects for doctors and nurses coming out of the medical and nurse training schools. The Government are keen to claim credit for committing substantial extra resources to increasing the number of people going into medical schools and nurse training so that a greater number of skilled clinicians is available to the NHS. However, they do not tell us that there is no model for the future funding of the NHS that offers job opportunities for all the people coming out of the expanded nurse and doctor training schools. Those who are coming out of the schools have a pretty significant vested interest in understanding the economics and dynamics. They have done the maths and know that there are not enough jobs to go round. We are heading into a period in which there will be unemployed nurses and doctors because the Government have got their staff planning wrong and are producing more trained doctors and nurses than the NHS will be able to employ in any likely scenario over the next decade. That is mismanagement of resources and is known to be such by those who work in the service.
There is a second area of mismanagement of resources of which people are becoming increasingly aware, and it is not dissimilar to the one to which I have just referred. The Government are proud that in constituencies throughout the country they have launched the biggest capital investment programme in the history of the NHS, and that throughout the country there are new, expanded and renovated hospitals that reflect that huge investment programme. The Government do not tell us—Steve Webb touched on this—that resources have been pre-empted elsewhere, and that the intelligent commissioners in the health service increasingly see that resources should have been made available in greater proportion to the development of the community-based and the less politically sexy aspects of the delivery of health care.
The NHS that the Government will bequeath their successors is one where major capital investment has committed resources for a generation to come that do not reflect—this is what the commissioners fear—the priorities of the NHS during the life of the investments that have been made and which have secured so many brownie points for the Government during their time in office. It is ironic that the Government should have issued a White Paper within the past 12 months stressing once again, as Health Secretaries have since Enoch Powell and before, the importance of moving health care out of the big general hospitals into the communities so that it is close to where patients live, is accessible to patients and uses the latest technology to deliver day case and ambulatory care, for example.
The Government talk the talk of the development of community-based health care while at the same time putting shedloads of money into a new district general hospital investment programme, which is preventing them from delivering the model of health service delivery that is so articulately described in the Secretary of State's White Paper.
Will the right hon. Gentleman comment on the shedloads of money, as he puts it, that are going through the LIFT schemes to build in communities the general practitioner practices to provide integrated services with social services and the voluntary sector? It seems to me that the investment is being made.
I am not saying that there has been no investment in community-based care. There has been a huge investment programme. As someone who supports the principles of the NHS, I welcome that investment programme. However, the Government must be held to account for a series of investment decisions that I do not believe in 10 years' time will represent the optimum use of that investment resource to support the delivery of health care that we will want to see, as described in the Government's White Paper.
Ms Johnson mentioned the LIFT scheme. I have had phone calls from and meetings with the people who are holding the finance. They are appalled by the behaviour of the Government because they cannot get them to make a decision. Does my right hon. Friend agree that part of the confusion is that nobody really knows what the Government's plan is?
I could not agree more with my hon. Friend. I think that we know what the Government's aspiration is, but we are seeing increasingly as the months turn into years that it is dawning on the Government, after it has dawned on those making the policy within the service, that they do not have enough money to deliver all the things that they want to do. They have lived in a world where somehow money was no object. They took the view, "We can do everything because we, the Labour party, are committed to the NHS." They are discovering that in reality all of us are committed to the principles of the NHS. The thing that marks the Government out is that they are only now starting to address the hard questions that must be answered if we are to deliver the objectives of the NHS that we all share.
I think that I have probably taken up enough time of the House. I shall conclude by saying that there is no division in the House—I know that it suits the party political purpose of the Labour party to assert that there is a difference, but there is in reality no difference—in terms of our commitment to the principles of the NHS. We, the Conservative Opposition, the Liberal Democrats and the Labour party, are all committed to the delivery of the core principles of the NHS: high-quality medicine that is available on the basis of clinical need and on the principle of equitable access.
The issue is which party is prepared to face the difficult questions that will turn those fine words into actions that are experienced daily by clinicians and by patients of the NHS. It is the dawning recognition on the part of those who work in the service that their political masters, over the past nine years, have been more interested in their political skins than they have been in the delivery of the core principles of the NHS that led to the Secretary of State receiving the reaction that she did to her words a couple of weeks ago.
It gives me great pleasure to follow the eloquent speech of Mr. Dorrell. We are told—breaking news—that the national health service faces a funding challenge. Was it not ever thus? I have been in the NHS now for more years than I care to share, and in every one there have been funding crises. We are in the difficulties that we now face because we are taking tough decisions that were avoided for far too many decades, let alone years. These decisions should have been taken many years ago.
I was talking extremely recently to someone who has been put in one of the turnaround teams to consider some of the failing and problematic primary care trusts, to see what he can do. He told me—this was off the record because he did not want to be quoted—"The problem is that because by avoiding making tough decisions for so long, because decisions have been swept under the carpet and because they have hoped that decisions will go away if they wait long enough, and because they hoped also that someone would come along and bail them out if only they kept their heads down, it was thought that everything would be all right." It is not all okay, and as my right hon. Friend the Secretary of State said, someone eventually has to make some extremely tough decisions. If not, the very fabric of the NHS will be undermined and under threat. It cannot continue as in the past.
The right hon. Member for Charnwood said that there are significant problems in producing too many medical students and too many trained nurses who will not be able to find jobs. Not only is that scaremongering for those people who dedicate their lives to the NHS, but it is not true. The NHS has imported doctors and nurses for the past 30 or 40 years because we have not produced anything like enough of them. The NHS has had an expanded medical school programme and an expanded nurse training programme so as to reduce our reliance on overseas trained nurses and doctors, who are often sorely missed by the countries we take them from.
We are accused by the Royal College of Nursing and the British Medical Association of stripping countries bare that can ill afford to lose their trained doctors and nurses. Yet now we are suddenly told we have far too many of our own doctors and nurses. It is not true. I think that we are training about 5,000 doctors a year. That is barely enough. Indeed, I do not think that it is enough to keep up with natural wastage in the form of people retiring, leaving, emigrating and so on. Far from producing doctors and nurses who will not have jobs, we will still find in future that we are short of doctors and nurses and will need to fill the extra places that we are creating.
My right hon. Friend Mr. Barron eloquently produced statistics to illustrate the increased number of operations, reduced waiting times and the new treatments that are available. That being so, I need not go into those matters in great detail. However, I shall raise one issue with the House, and that is nurses' pay. Nurses are angry. We have heard many theories about why they might be so angry.
There was clearly an organised demonstration. As a former full-time union official I was capable of doing exactly the same thing when the Conservative party was in Government.
I am interested to hear that from my hon. Friend. I do not wish to make points about the Royal College of Nursing. I speak to nurses daily. I talk to these people. Many have told me that they are embarrassed by the way in which their leadership has portrayed them in the media and has allowed them to be undermined, as well as allowing them to abuse the hospitality of the Secretary of State in the way that they did. That was unforgivable. I do not blame nurses for that, but I point the finger at some of the leaders who purportedly speak on their behalf. Let me cite some important statistics. Minimum starting pay for nurses is £19,000—a 55 per cent. increase since 1997. Nurse consultants start on £49,000 a year, senior professional nurses can earn up to £88,000, and modern matrons start on £35,000 a year. The typical starting pay for a junior doctor is £30,000—an increase of 40 per cent.—and a grade F nurse who earned £21,000 in 1998, received £28,200 in 2004, which represents a 23 per cent. increase. I could speak about those increases indefinitely, but it is not about pay or numbers.
As a general practitioner, is the hon. Gentleman embarrassed about the huge rises for general practitioners without a corresponding improvement in performance?
The hon. Gentleman makes an interesting point, but I am not embarrassed at all, as most GPs do not earn anything like the figures that appear in the newspapers. According to the British Medical Association, the average pay for a general practitioner is £90,000 to £95,000, which is a reasonable rate for a good job. GPs undertake considerably more responsible work than before, and I shall come on to some of the things that they did not do a few years ago. For example, they have taken on some of the acute hospitals' work load—five or 10 years ago that would not have been possible—and they can provide facilities that they did not have at their disposal only a few years ago.
The hon. Gentleman spoke about nurses' pay, but Macmillan nurses in Shrewsbury earn £5,000 a year less than Macmillan nurses on the same grade down the road at Wolverhampton. Does he share my concern about regional differences within such a small area, given that we may lose some of our Macmillan nurses to Wolverhampton?
The hon. Gentleman is right. Those are matters for local decision making. It is not my responsibility to set the pay rate for nurses in different parts of country—it is not even Ministers' responsibility—as primary care trusts and other employers set pay scales. GPs can pay nurses according to their skills and expertise. That is not a matter for the Government or for me—it is for nurses' representatives to negotiate a rate with the employers, and that is how it has always been done.
My hon. Friend said that he will come on to GPs' extra responsibilities, and I should like to correct an embarrassing slip of the tongue. I remind the House of what happened under GP fundholding, and the difference that we see in current GP practices.
There are some incredible differences between the way in which GPs were treated before and how they are treated now, and I shall expand on that later.
I want to look at what we can do in the community to expand health care and health care facilities. The community services White Paper called for far more services to be delivered outside hospital, along with practice-based commissioning and new initiatives on prevention and chronic disease management, thus demonstrating that the NHS can become leaner, fitter, much more efficient and capable of delivering much greater value for money. I am concerned, however, that those reforms may not be sufficient to reshape the health care landscape in favour of primary care. How can we reconcile the goal of moving more care closer to home and encouraging more integrated pathways of care with the Government's determination to allow more acute trusts to attain foundation status and to operate independently?
One problem is that, as a result of the NHS tariff system, acute sector providers are encouraged to try to generate as much business as possible to maximise their income. There is an increasing incentive for hospitals to treat more people more regularly than before, and I am afraid that that will put pressure on the NHS. Some have argued that more competition between trusts as a consequence of practice-based commissioning will help to negate any inflationary effect arising from the tariff-based system. Underperforming providers will be squeezed, and commissioners will seek to secure the greatest possible value for money. However, it is dangerous to rely on the market alone to achieve the reduction in acute activity needed to achieve the goals that the Government set out in the White Paper. Not only will that lead to imbalances in the way in which acute care is delivered but it will encourage acute trusts to concentrate on more lucrative health care activities at the expense of less lucrative ones.
Moreover, the experience of countries that have sought to shift more care into the community is that change is slower in health care systems composed of powerful, autonomous hospitals that compete with one another for patients. Having invested so much political capital in the foundation trust model, the Government would find it inconvenient to curb the very freedoms that it has worked so hard to give hospitals. Without a concerted and meaningful attempt to blur the boundaries between primary and secondary care to achieve vertical integration between the two sectors, we cannot achieve the vision of a prevention-oriented, primary care-led NHS that the Government wish to deliver.
Simply encouraging more consultants to see more patients in primary settings is not the answer. Primary and secondary-care consultants and professionals must be answerable to the same paymaster—a single care trust that it is openly committed to an integrated, primary care model—if we are to achieve meaningful change and resolve the problems facing the NHS. We could learn a great deal from the Kaiser Permanente model of health care in California, which has reduced secondary admissions and kept hospital stays to a minimum in a wide range of specialties. It owes much of its success to its decision to invest in a network of community-based specialty clinics, in which primary care professionals work alongside specialists. Those clinics have the facilities to cater for virtually every step of the patient pathway, from initial assessment to diagnosis, treatment and follow-up appointments.
One aspect of the Kaiser model is crucial to its success in reducing acute sector activity. Unlike the NHS, there are no structural distinctions between primary and secondary care. Not only is the model vertically integrated but the entire care package is based on prevention, integrated working and a belief that the most effective treatment is delivered as close to home as possible. The specialist doctors and nurses who work for Kaiser tend to support that model. It has been extremely successful, and we could learn a great deal from it.
The hon. Gentleman is making a thoughtful contribution. If we blur the distinction between primary and secondary care, should we therefore blur the distinction between health and social care, and merge those budgets, too?
Yes, I believe that we should. A few years ago, when I was a member of the Select Committee on Health, we looked at that issue and recommended blurring the boundary and breaking down that Berlin wall to achieve much more integration of budgets and personnel so that people work across both sectors.
If we removed the boundary between primary and secondary care, we could provide the care that the patients need, whatever the location, without competing pressures between social and health care, or between primary and secondary care. The system would be much smoother, and patients could understand it. It would achieve what they want and deliver efficiencies. I would go further, as we need to ask what is the role of the acute hospital in the 21st century. That dangerous question needs to be handled subtly—Members on both sides may fear that there is threat to their own unit—but we must have that debate. An acute unit capable of delivering emergency care, followed if necessary by transfer to a more appropriate unit after stabilisation, is required in each district, but what should be provided beyond that? Does the district general hospital need all its acute beds? Is that requirement appropriate in every instance? Is it appropriate for every speciality to be provided in every district general hospital? Do we need a full range of services in each unit?
The vast majority of acute admissions are entirely avoidable, particularly for people with chronic conditions such as asthma or diabetes. Those admission should be regarded first and foremost as a sign that the system has failed. If I have to make a phone call as a GP to admit a patient to hospital, I always ask what went wrong with their care package. Sometimes there is a simple answer—they have had a heart attack or stroke and need to be admitted to hospital to be stabilised and treated—but often there is a failure of social care. I have to send a patient to hospital, because there is not a safety package in the community that I can put into action fast enough to enable them to stay in their own home.
When we send a patient to hospital, it is usually a nightmare. Elderly people, in particular, become institutionalised after only a few days, and it is much more difficult to rehabilitate them so that they can return to their own community. They become disoriented and, all too often, end up spending a long time in hospital or being transferred from hospital to a social care bed, all of which could have been avoided with more planning and blurring of boundaries. Putting people in hospital is expensive, and in many cases it is harmful to their health, particularly to their psychological well-being, as most people would far rather be treated by their family and friends in a familiar environment. Hospital-acquired infections are, by definition, acquired in hospital, not in the community. Far too many people succumb to those.
Reviewing acute sector capacity is not just financially desirable, but essential from a clinical and a patient perspective. In the early 1960s, when the present model of the district hospital was developed, there was a need for large-scale repositories in each area, given the rather limited range of treatments that we could provide and the rather rocky patient pathway that many people followed. It was inevitable that people were kept in hospital for long terms. When I was a junior doctor, I remember working in a district hospital that had access to 1,000 beds, and we were always full. I used to admit acute surgical patients to the ear, nose and throat ward because I had nowhere else to put them. That was 20 years ago. We now have far fewer beds and do not face anything like the same pressures on the beds. Times have changed.
Although I agree that we can have a carefully reasoned debate about acute care strategy, there is a threat in my constituency of losing our accident and emergency department at Chase Farm hospital and of its being transferred to Barnet hospital, in the context of dealing with a £31 million deficit, and the financial concerns are paramount to residents when they see that they may lose their A and E department just to save money.
Obviously, each area has its own problems. I cannot comment on the hon. Gentleman's area because I do not know it. I am suggesting a debate on a much wider scale than individual hospital budgets. I am suggesting that we have a debate on the meaning of the acute hospital in the 21st century and whether we need to provide care in the way that we are currently providing it.
I shall give the House another example. I have recently met several consultants—one came to my practice only the other day, to ask why there are so many fewer admissions and referrals to his hospital than before. His first thought was that perhaps the hospital had become unpopular and that we were sending patients elsewhere. In fact, we are not sending them anywhere. What GPs are doing is keeping far more people than ever before in their practices. They are all running diabetic clinics, chronic obstructive pulmonary disease clinics, asthma clinics and minor surgery clinics. Treatments that were impossible 10 years ago are now routine and commonplace in general practice. Patients like being treated in their own practice. We are therefore not making the referrals to hospital.
I would go further. I spoke to a consultant cardiologist the other day, and he was not joking when he said that heart attacks—coronary thromboses—were becoming a scarcity in his hospital. He said that the cardiac unit was having to look around for other things to do because there was no longer a steady flow of cardiac problems. Why was that? "Because," he said, "you GPs are preventing them. Because you are treating people with high cholesterol and blood pressure, managing diabetes, coping with the effect of their obesity and their smoking, we are not seeing the heart attacks that we saw before". In other words, we are already seeing a fall-off of need.
My acute hospital in Dartford, the Dartford and Gravesham NHS Trust at Darent valley, was built as a private finance initiative hospital a few years ago, one of the first since the Government came to power. When it was being planned, I was vilified, the NHS was vilified, everyone was vilified in the press because, it was claimed, the hospital would be far too small. It was replacing three hospitals with one hospital, and the result would be chaos, meltdown, disaster—all the usual hyperbole.
Only last month I went to see the chief executive and asked how he was getting on. He replied, "Far from being too small, we are planning alternative strategies as to how to use our capacity in the coming years, because the pattern of admissions has changed. We are not seeing the queues of ambulances outside that were predicted. We are looking at our hospital in a slightly different way and seeing what alternative services we could provide with the space that we have." Not only has he got enough space, but he may have more than he needs for the future. He is facing up to that and considering other ways in which his hospital might be used in the future. That is extremely good.
Far from the hospital service being static, it needs to be dynamic. I share the view of the right hon. Member for Charnwood that we need to consider the future of some of the facilities that we are building, including large-scale hospitals. Patterns of care are changing so rapidly, and so many more people are treated as day patients than ever before, that we need rational debates about whether we need so many beds or so many units and what we should do with the facilities that we are building.
I appreciate that many Members want to speak, and I do not want to go on too long. We must have these blue-sky debates in the House. Instead of hurling abuse at each other across the Chamber, I would much rather have a constructive debate with Opposition Members and the third party. What do we do with the health service? What should the health service stand for? It may be true that we are all in favour of the health service, but we have slightly different visions of it.
My vision is of a health service geared to patient need, where the episodes of care are delivered where it is best for the individual patient—not where it is best for the service, the Royal College of Nursing, the British Medical Association or Unison, but where it is best for that individual patient. My gut instinct is that patients being treated in their own home by their own practice nurse, their own doctor and their own team of associate support staff is the way to go. Big acute general hospitals are probably not the way to go. The interesting debate will be about how we get from here to there, and I look forward to many more of these debates in the future.
I begin by saying how fascinated I was by the speech of my right hon. Friend Mr. Dorrell, and how right I think he is in his remarks about the nurses. I deeply regret the way the nurses treated the Secretary of State. It was a mistake on their part. It was clearly organised, and it was a foolish demonstration. I agree with Dr. Stoate that nurses are far better paid than they were, and so they should be. That manifestation was not about pay at all. It was about the constant rate of change in the health service, which is proving so destabilising and bringing such great uncertainty not only to those who work in the health service, but in the long term to patients.
In speaking to the motion, I commence with the words of the magnificent Jeff Randall, one of our foremost economic correspondents, who remarked in his column the other day that it takes a very special, not to say a unique, genius to triple state expenditure on the NHS in 10 years to £96 billion, while simultaneously creating a financial crisis of such severity that perfectly good hospitals are closing, wards are having to be shut down and services cut, thousands of highly trained nurses are losing their jobs and there are few jobs for newly qualified doctors.
In the south-east of England a health care crisis is developing throughout the region, and dealing with it will be extremely difficult. The Chancellor made a colossal error by announcing massive increases in public expenditure on health without demanding substantial productivity gains and further reforms. A very great deal of taxpayers' money has been wasted and is about to be so again, and there is a substantial managerial failure which lies at the door of the Department of Health. It is not a failure, by and large, at local level.
Let us start where credit is due. The NHS needed more money spent on it. There has been a broad improvement in a substantial range of services and the right hon. Lady is to some extent right to feel that the press, as always, concentrates too much on the reporting of people's negative experiences. All of us Members of Parliament know that serious complaints are made, but on the whole my postbag is filled not with complaints, but with letters from people saying how well they were treated and how grateful they are to the doctors and nurses for their skill and care.
However, much too much money is being wasted in the health service. For example, after seven years of wasted planning time, St. Mary's hospital, Paddington decided not to replace its Victorian buildings with a new hospital, by which time the trust had spent £14 million on consultants' fees. That is not acceptable, and there are many such examples.
There is a mixed picture, and in respect of my own constituency I shall say something about the Princess Royal hospital and the Brighton and Sussex University Hospitals NHS Trust. I have raised these matters on the Floor of the House on a number of occasions and at a series of meetings with Ministers, and I do not want to go over old ground. As I have said before, the trust is £21.3 million in debt, with no possibility, in my judgement, of paying it off in the time scale required. A similar point was made earlier.
I warned the Government at the time the trust was created what would inevitably happen when the two hospitals were merged. The position now is that a turnaround team has reviewed the situation with the trust managers and it is my firm conviction that, unless the debt is dealt with in a sensible manner—we must leave headroom and time to support a full recovery process—the trust inevitably will have to make substantial cuts in services, close wards and reduce vital services for local people. That cannot be what the Government want and it is certainly not what my constituents want. It would be a disaster locally and would, I am afraid, further damage my constituents' confidence; already bruised following the "best care, best place" consultation.
I appeal to the Minister to accept that the trust is struggling with long-term financial burdens; they are not its fault and are, frankly, beyond resolution. The Government should not reward poor financial stewardship, but where such a situation exists—as it does with this trust and many others in the country— alongside a genuine commitment from the management and capacity to reform and increase transparency, the Secretary of State should act in a sympathetic and understanding manner.
I want to speak briefly about the future of the NHS. The national health service employs 1.3 million people. In Surrey and Sussex alone—my part of the world—the budget is £2.8 billion and the NHS employs more than 50,000 people. On any one day, 4,500 people will be occupying a hospital bed and 1,100 will be admitted to hospital, of whom 720 will return home that day. About 2,350 people will attend an accident and emergency department on any one day in Surrey and Sussex, of whom about 560 will be admitted.
The local Surrey and Sussex health economy is now in great difficulty, from which it will be difficult to extricate itself. It is not possible any longer to run an organisation of this size as it is, and I believe that change is required, particularly around the issue of accountability at all levels. I applaud the work that the Government are carrying out to try to get that done, but I firmly believe that we need significant devolution of responsibility, autonomy and accountability at the local level and that it will be possible and equitable only if managers and clinicians are able together to set local strategies, targets and service delivery. They should be agreed by the strategic health authority, monitored according to that agreement and set within the SHA's financial framework, aligned to the strategy of the Government of the day.
The NHS will never work efficiently and truly effectively until empowerment and ownership of services and service delivery are an absolutely integral part of the success of achievement. At present, many of the clinicians to whom I speak are, as my right hon. Friend the Member for Charnwood argued so effectively, feeling disillusioned and disconnected from the process and restrained. Managers who, given their heads, could do a much better job, feel disempowered and are unable to take initiatives that they know to be right. Only in genuine partnership will clinicians and managers be able to deliver the sort of dynamic service that is really responsive to the needs of patients. We need that to happen now and the Secretary of State needs to do more to encourage it and to make it happen.
It has always been my experience in public life that pay is not the only driver for those who work in the NHS or elsewhere in the public services. Job satisfaction, improving patient outcomes, applying new and valuable initiatives and good systems changes, alongside feeling valued and respected, are just as important. Ethos matters very much to most public servants. There are some outstanding managers in the NHS, but there are also too many inadequate ones who are recycled from job to job. The good ones need to be nurtured and developed. Initiative, and particularly risk taking, needs to be encouraged and managed.
I have a suggestion for the Minister, which he is at liberty to use. I believe that the Government should set up a staff college, based on the services model, to which all managers marked out for further and higher command above a certain level in the NHS have to attend. Such a course could be run at business schools throughout the country to ensure that only the very best managers go on to the most important jobs. As in any other business, the leadership or senior management is absolutely crucial to the success of the enterprise. The NHS should be no different, so my right hon. and hon. Friends are right to be critical of the Secretary of State in that respect.
In the last five years, the NHS budget has increased by 40 per cent. in real terms, while output has increased by less than half that. In its doctors and nurses, the NHS has one of the most committed work forces in the country, yet management has significantly failed to motivate and engage those dedicated professionals towards a common goal of increased productivity.
The hon. Gentleman is perpetuating—unintentionally, I am sure—a bit of a myth here. Of the significant extra tranches of money invested in the NHS, it has been clearly demonstrated that 48 per cent. has gone into new posts, operations and new drugs; 30 per cent. into pay, which needed to be tackled; and a further 18 per cent. on capital investment, environment, equipment and so forth. Those are not unreasonable figures, so the suggestion that it is all somehow dribbling down the drain is not worthy of the rest of the hon. Gentleman's speech, which has otherwise been excellent.
I am attempting to suggest no such thing. The hon. Gentleman is right about capital expenditure and all the rest of it, but I am suggesting only that for an investment of this size, one would expect to see a greater degree of productivity right across the board. It is a fact, as the hon. Gentleman well knows, that the inefficiencies in the health service are legion. The way the NHS does its business is still many years behind what goes on in the private sector. I am not suggesting that the private sector is necessarily a perfect role model, but the NHS has many lessons to learn from how the private sector runs its affairs.
I am going to press on with my speech.
While the "payment by results" initiative has brought the impetus to improve productivity in the NHS, the real challenge lies in empowering and engaging its front-line staff and getting them to take personal responsibility for the performance challenge. That is a technique that has been implemented time and again in the private sector to very great effect.
I want to conclude by saying that the national health service is, in my judgment, a truly remarkable organisation, which is greatly valued by the people of this country, but it could be and should be so much better than it is. There is nowhere better to be, frankly, if people are really ill, and I know that most of the people who work in the NHS find the teamwork and comradeship extremely rewarding. Most feel that it is a great privilege to work in the NHS, but they all have one thing in common, as eloquently argued by my right hon. Friend the Member for Charnwood: they absolutely yearn for a period of stability. They yearn for the ability to take the best decisions for their local communities, to provide the best care that they can, and to deal with the abuses and inefficiencies that are all too rife. Many of the NHS's difficulties are systemic and the deficits can be wiped out only by fundamental change: the NHS and its people, wherever they work, need the time, the space and the resources to achieve it.
The Opposition motion, which
"calls on the Government to appoint a turnaround team to the Department of Health", is not so much tongue in cheek as foot in mouth. The Conservative party has opposed every penny of extra money that this Government have put into the NHS. As an alternative to our strategy, its current leader has, so far as we can tell, designed the patient passport, fought a general election on that issue and then ditched the policy. It is the party of GP fundholding, unfair competition and constraints on NHS spending, which lead to growing waiting times and waiting lists.
We have got every reason to be proud of what the NHS has achieved. If we think back to when my hon. Friends and I were elected in 1997, we realise how things have changed. We have already doubled spending since then, and it will have trebled by 2008. We were spending at well below the European average on health after years of Tory cuts, and waiting was the keynote that typified NHS services in those days, whether it was waiting on those ever-increasing lists for operations, waiting on trolleys in accident and emergency units or waiting for winter to end—the extra deaths caused by winter used to generate fear every year. In my first few years as a Member of Parliament, I used to receive far too many letters from constituents who did not know whether they would get their hip or knee operation done or whether they would die first. We used to get letters like that, but I am delighted to say that I have not received one for some years.
At that time, the health service in my constituency was typified by the Devonshire royal hospital, which rattled around inside a magnificent grade II* listed building. The building was in a poor state, and, although people were fond of it, few High Peak residents used it as an in-patient hospital, because it was a centre of regional excellence for head injuries and rheumatism treatment in the north-west—it happened not to be in the north-west region, which was one reason why its closure was proposed. Many people were against the closure, but when the hospital closed, no services were lost. Out-patient services were transferred to the two community hospitals or, as is increasingly the case, to GP surgeries. Now, nobody would attack the decision to close that hospital on the basis of the health care that is provided in the area.
I am grateful to the hon. Gentleman for recognising that hospital closures and mergers can occasionally play an important part in improving services within the NHS. Does he therefore condemn the actions of previous Labour Oppositions, who used hospital closures and mergers as a political football to try and attack the Government of the day?
Although there are no acute hospitals in the High Peak constituency, we have got a foundation three star hospital at Stockport Stepping hill, which is on the outskirts of my constituency, and a brand new hospital, which is awaiting the outcome of its foundation application, is about to be built to replace the present Tameside hospital. No one waits for four hours in A and E in either of those hospitals, and in-patients, who typically faced a 12-month wait in 2002, now wait for less than six months. Out-patient waits in the area were typically 21 weeks in 2002, but they are now less than 12 weeks.
There are two PCTs in my constituency—Tameside and Glossop and High Peak and Dales—and they are both hitting all of their key targets, which benefits their patients, providing more and more services within communities and working closely with an excellent team of GPs. Furthermore, an increasing number of non-GP health staff are working inside GP surgeries delivering basic community health services. As far as Tameside and Glossop PCT is concerned, Shire Hill hospital in Glossop has now achieved step-up, step-down status, which means that people who do not need to take an acute bed can use a GP bed in that hospital. Similarly, people who have been in an acute hospital can use that hospital as a staging post on the way home. A walk-in centre will be built in Glossop through the local improvement finance trust programme, and I am delighted to say that the town has a high level of registration by dentists. Tameside and Glossop is an historically low-funded area, so I am pleased to say that it is getting a 9.4 per cent. increase this year and a 9.3 per cent. increase next year.
High Peak and Dales PCT also has a record of excellence, although the locality is different. The Corbar maternity centre is a centre of excellence, and it was recently reopened and reinvigorated in Buxton. The Stonebench ward is one of the most deprived wards in my area, and for the first time it has both GP and dental services provided through PCT investment in the Sure Start programme. It also has the first four dentists employed by the NHS who do not have the option of going private. That historically high-funded area will still get an 8.1 per cent. increase this year and an 8.2 per cent. increase next year.
There is an issue about the High Peak and Dales PCT budget, because—sin of sins—the PCT has overspent by 1 per cent. on its 2005-06 budget, which has resulted in the closure of the minor injuries unit in Buxton for eight hours a day between midnight and 8 am and the failure to bring an elderly person's ward at the Cavendish hospital back into use after refurbishment. I agree with the protestors who say that the minor injuries unit should be available 24 hours a day, and I hope that the PCT will make sure that it comes back into service in one form or another. Between midnight and 8 am, the unit used to serve an average of two people a night—on average, one of them would go to A and E, while NHS Direct would probably be able to deal with the other. Nevertheless, public pressure is such that the situation requires a response. Equally, I agree with the PCT that the elderly ward should be brought back into use first when the money becomes available. In dealing with that minor overspend, no redundancies have been necessary, and I hope that the situation will be corrected before too long.
Like PCTs in other areas, PCTs in my area face reorganisation. Tameside and Glossop PCT is perhaps the only PCT which straddles a regional border—Tameside is the north-west region and Glossop is in the Trent region. Greater Manchester SHA has proposed that Tameside and Glossop should stay together, which recognises the local affinities, the local needs of Glossop, transport connections and travel-to-work areas. Indeed, 1,601 people replied to the public consultation in Glossop, of whom 1,597 supported maintaining the current link. Greater Manchester SHA only consulted on that option, while Trent consulted on four options, two of which would take Glossop back into Derbyshire in order to make a Derbyshire-wide PCT, which would be coterminous with social services. I understand that argument and see why social services and health services should be run according to the same boundaries, where no overriding feature exists. However, because of the geography of Derbyshire, and, in particular, the geography of Glossop, it is essential to maintain the link between Tameside and Glossop, and I hope that the Minister will announce the adoption of the status quo when he makes the announcement in a couple of weeks' time.
I have already mentioned Corbar maternity unit. For some reason, the whole of High Peak is included in the north-west region, where a number of options are currently being considered for maternity and children's services. The consultation is open until the end of this week, and the large number of such units will be reduced to eight or nine in the Greater Manchester and north-west area, with the aim of improving staffing, quality, investment and opportunities for excellence.
That idea has come from within the NHS itself—it is not being imposed from elsewhere. I am happy to tell the Minister that I have supported option A, which is already the preferred option, because it not only retains Corbar maternity unit in Buxton—in fact, all the options do that—but is the only one that maintains the maternity services at Tameside.
Having said that, if Ministers find that there is an opportunity to show some flexibility, they might acknowledge that the reduction in choice from 13 or 14 units to around eight is a bit drastic. Perhaps they could consider the possibility of including Macclesfield in option A, because choice is an issue here. As someone who is used to representing a constituency on the fringe of a region, I am aware that one usually does not have as much choice as one does elsewhere.
The NHS has been a huge success under Labour. More staff are employed and they are better paid than ever. There are more community services and more flexible services. There is an imaginative use of private capital to support and expand, not replace, public services, and there will be more to come. In the NHS, change is always difficult and challenge is always complex. Champions of health care, especially in our most deprived communities, are worth their weight in gold. The principles on which the NHS was founded, which, we are told this afternoon, are espoused across the Chamber, are safe with this Government. Equally, the funding that has been championed only on this side of the House is safe with this Government. We have a job to do with the NHS—let us get on and do it so that we have a better NHS for all.
I remain absolutely convinced that my constituents are fortunate indeed to live where they do and to be served by the national health service, and I make no apology for that. Labour Members who have implied that there is no common ground between us and that some of us are not committed to the NHS do themselves, and us, no justice whatsoever.
I caution Labour Members who have quoted reams of statistics at us with the intention of giving the impression that things are much better than they appear. I recall listening to "Yesterday in Parliament" during the late 1970s and mid-1980s, when Mrs. Thatcher was challenged week after week on the state of the NHS. She always answered robustly from the Dispatch Box with reams of statistics saying how many more operations had been carried out and so on. Even in those years, despite the myths that may be spun, the NHS was improving. Nevertheless, it did not work, because it did not match up to the ordinary people's perceptions based on their experiences. That is the problem that my constituents are having at the moment. Their perceptions of what is happening in the NHS are informed by the difficulty, or otherwise, that they face in seeing their doctor or dentist.
I should like to give hon. Members an impression of what it is like in my part of the world. We have a vastly expanding population. As the Deputy Prime Minister's rules, particularly on density, begin to bite in urban centres such as New Milton, and townscapes are changed for ever as family houses are pulled down and replaced with blocks of flats, the population is expanding fast. Yet only one GP practice south of the A337 is still taking on new patients. That outgrew its existing premises some time ago and is short of space, whatever measure one chooses to use, and sometimes the cramped conditions in the waiting room are unacceptable. A few years ago the practice secured the primary care trust's permission in principle to expand its premises, but before it could do so, a directive from the Department of Health instructed that that was not to happen because the funds were to be allocated not to the primary care trust but to Hampshire as a whole. Hampshire's priorities are different; they apparently lie in Portsmouth. There is now not the remotest chance of that practice, or any practice in my constituency, being able to expand its premises.
My constituents write to me in droves complaining that they can make an appointment with their GP only on the same day. It does not suit most people to have to spend hours ringing the surgery in the morning, only to find it engaged, when they would like to organise their lives so as to see the doctor at a time convenient to them, as they used to in the past. They feel that the situation is not as good as it was before. That is entirely a consequence of the targets to which general practitioners have been subjected.
During the election campaign, on the "Question Time" interview, the Prime Minister was confronted with that problem, appeared greatly surprised, and said that he was going to do something about it. I have not noticed any result. I have written to the Secretary of State saying, "Please find enclosed a copy of a letter from my constituent complaining about X, Y or Z. I remember the Prime Minister saying he was going to do something about it—what has happened?" The answer is, "You can rest assured that patient satisfaction will be one of the measures on which general practitioners will be remunerated in future." That does not deal with the perceived deterioration that my constituents experience in booking an appointment.
Let us examine the possibility of booking an appointment with one's dentist. A couple of years ago the situation deteriorated. It got so bad that constituents of mine who were lucky enough to have an NHS dentist were receiving letters telling them that there were not going to be any more NHS dentists, but they were welcome to stay on as private patients if they wished. When I raised that at Prime Minister's Question Time, the Deputy Prime Minister, who was answering on that occasion, said :
"I am well aware of the problem that the hon. Gentleman mentions because I have experienced it. My dentist declared that he was going private and I declared that I could not stay with him. Many of our constituents have faced this problem. As the hon. Gentleman said, each one of us has been confronted with it."—[ Hansard, 9 June 2004; Vol. 422, c. 270.]
That does not actually address the problem. He went on to tell me that it was all the Tories' fault for having closed down the dental schools. A decision by the university grants funding body more than 10 years ago is not germane to our problem now. The problem is that NHS dentists are leaving the NHS. It is not a question of a shortage of dentists but of how they are employed.
The problem got worse. Several constituents wrote to me complaining that they had received a letter from their dentist saying that he was no longer going to be an NHS dentist but would nevertheless continue to treat their children under the NHS as long as they, the parents, remained as private patients with the practice. They did not like being held hostage in that way, but felt fortunate at least to have their children still being treated as NHS patients. The Secretary of State acted to right that perceived wrong. Instructions were issued to primary care trusts whereby they were empowered to prevent dentists from maintaining children-only NHS lists. So in the past few months, parents in my constituency, particularly vulnerable families, have been receiving letters from those self-same dentists saying, in effect, "You will recall my letter of such and such when I undertook to keep your children on as long as you remained as a registered private patient at the practice—well, sorry, that deal is off and your children will either have to find another dentist or stay with me and pay." That is a very worrying letter for the many families with children who have orthodontic requirements and all sorts of work to be done.
As a consequence of the Government's policy, it is much more difficult to secure NHS dental treatment. However, my constituents have been told that the seventh cavalry is on the way, and that some 12,500 new dental registrations will be available to the good people of New Milton. To take advantage of those as yet virtual dental registrations, a new model is to be used to avoid the inconvenience—and, of course, the attendant unpleasant publicity—of long queues forming and being photographed.
The people of New Milton have been invited to telephone a number to secure their dental registration. I have a letter from a constituent who tried that. The announcement was made in February and he began to make telephone calls. The letter states:
"Since then I and friends have telephoned this number many times only to hear an automated voice saying 'The number you called is busy. To ring back please press five'. Furthermore, if you press five a similar voice tells you 'Sorry, there is a fault please try again'."
He writes that he tried the number on
We have been told that the position on waiting times has changed; the claim was repeated today. We are told that a magnificent improvement has occurred, but that is not the experience of many of my constituents. At previous Health questions, I asked about audiological waits in my constituency. It has a disproportionate number of elderly people, and thus a disproportionate number suffering from poor hearing, which is one of the most socially isolating experiences. As I said in Health questions, there is a significant danger that many patients will die before they secure the hearing aids that they require.
Strangely, I received a letter about the problem today—although it is not an amazing coincidence, because I am afraid that I receive such letters almost every day. My constituent's 17-month wait for a hearing test was over in February. His appointment was on
"A reliable person tells me it ought to take... say, a fortnight."
He waited and waited. After a further three months, he rang the hospital to find out what had happened to his hearing aids, only to be told that it would take another six months before they were delivered. That is a measure of ordinary people's experience of the health service. Can we blame them if they believe that it is getting worse?
We have five community hospitals in New Forest. We launched a massive campaign in the past year to save them because the primary care trust intended to close them. It backed off and said that it no longer planned to close them, but that it would have to work with the community to find a role for them—exactly the model that the White Paper, which the Secretary of State launched, set out. There was, therefore, progress.
However, community hospital supporters now experience huge frustration and staff morale is low because nothing has emerged from the process. Whatever is suggested about the role of a specific hospital—whether in Fordingbridge, which could be a centre for best practice or nursing excellence, or the hospital in Milford on Sea—the PCT response is that there is a difficulty because it is building a new hospital in Lymington. That is one of the first new hospitals in which the PCT will employ a private supplier to provide the health care. It does not yet know what services will be provided at Lymington, and will not therefore make any commitment about the services that need to be provided in any of the community hospitals. The new hospital in Lymington is due to open in January next year. Is that the way to run a national health service? We are only a few months away from the opening of the new hospital, yet we are told that decisions cannot be made about existing community hospitals because the PCT does not know about the services that it is commissioning at the new one.
I understand my constituents' frustration and anger. They say, "Yes, expenditure on the NHS has increased enormously, as have our taxes—but have we had value for money?"
I am delighted to be able to make a contribution to the debate because my constituents have experienced great improvements in the NHS since the election of a Labour Government in 1997. In contrast to Mr. Swayne, I have experienced—as a Member of Parliament, a lifelong resident of my area and, most personally important, the daughter of two very elderly parents—the most fantastic improvements in the local health service.
The improvements are due to the work of dedicated staff, as we have heard, and the investment in facilities, to which the increase in the money spent on the health service has directly led. Those improvements are tangible. The south-west London elective orthopaedic centre in Epsom has ensured that the waiting time for hip and knee replacements is less than six months. I have been a direct beneficiary of that centre because my mother, a nurse who was forced into early retirement by being made redundant in the 1980s, has had two hip replacements in the past three years. Her care has been fantastic and I thank the Government and the doctors and nurses for that treatment.
My father is 82 and, for him, the introduction of targets for waiting times has been fantastic. At accident and emergency in St. George's hospital, he was seen in less than four hours. Within 48 hours, he was diagnosed with bladder cancer, of which, thanks to the care of Mr. Bailey and his oncology team, he has now been cured. That is Government and staff working together—real people, not bluster or amazing, screaming headlines.
My experience is of not only my parents but my constituents. In my first three years as a Member of Parliament, I received regular letters about St. Helier and St. George's. Patients said that the wards were dirty and the care was poor. Such letters have, thankfully, reduced to a trickle.
Conservative Members may not like it, but they have so much previous on the health service that my constituents will not forget what they did to it in the 1980s and 1990s. They remember the winter bed crises, the people dying on trolleys and patients forced to wait in pain for two years for their operations. They remember our last local community hospital. I am glad that some Conservative Members have five, but, in 1992, our last community hospital—the Wilson—was closed.
There is a lot of talk these days about health inequalities. I genuinely appreciate that, because we were never allowed to talk about them under the Tories, as people's poverty and working lives supposedly never affected their health. The Tories closed the hospitals in the poorest areas of the country, affecting the most vulnerable people.
Since 1997, the amount of money invested in the NHS each year has doubled, and the number of people serving in the NHS has increased by 300,000. That is a measure of the Labour Government's commitment to the health service. Instead of having to go to dingy, dirty, run-down hospitals or watch much-loved hospitals such as the Wilson close, my constituents are now experiencing something completely different.
The Wilson is scheduled to reopen, and almost all our GP surgeries have had facelifts or have even been rebuilt as state-of-the-art health centres. Those include Dr. Sheikh's surgery in Middleton road, Morden, the surgery of Dr. Patel and Dr. Ganesaratnam at Wide Way in Pollards Hill, the Tamworth House medical centre in Longthornton, and Dr. Colborn's surgery in Figges Marsh in central Mitcham. And only two weeks ago, in the teeth of opposition from Conservative councillors on Merton council, we obtained permission to build a new surgery at Ravensbury Park for Dr. Arulrajah. That will be a great surgery for people who need a new hospital.
Most importantly of all, we have recently received the Secretary of State for Health's support for a new critical care hospital that will be the envy of everyone in our area. If hon. Members want to see an example of how this Government are tackling inequalities, they could do no better than to take a trip to look at health services in Mitcham and Morden. My constituency is probably the most disadvantaged in the whole of Surrey or outer south London. The Tories' approach to that inequality was to take away our health services, force us to cope with grotty GP surgeries and shut our hospitals. Labour's attitude involves doubling investment, building brand new GP surgeries and health centres, and reopening and rebuilding our hospitals.
Sadly, however, there are still some who share the ethos of the Tories, who believe that health care should go where the people shout loudest, rather than where the need is greatest. I do not wish to criticise dedicated and hard-working NHS doctors, nurses, ancillary staff and managers who share our commitment. However, there are still a few people in place who take a bureaucratic approach to health care, rather than a human approach.
I have first-hand knowledge of the commitment of this Government to confronting and dealing with health inequalities. Earlier this year, more than 250 people from two council wards in the south of my constituency braved a freezing February evening to attend a small celebration that I hosted to thank the Secretary of State for Health for saving and agreeing to rebuild their local general hospital, St. Helier. They wanted to thank her for listening to their concerns. Many of them were elderly or infirm, and they have suffered for years as a result of inequalities in the health service. They wanted to celebrate because they were so delighted that, in order to tackle health inequalities, an earlier decision by some in the health establishment about where to locate their new hospital had been overruled.
I will not give way.
As I have said, my constituency is one of the most disadvantaged in our strategic health authority's catchment area, with some of the greatest health needs, yet when the axe had to fall throughout the '80s and early '90s it was my constituency that suffered most. In the past few months, we have uncovered secret plans by the local health authority dating back to the mid-1990s. It proposed to shut St. Helier, but thankfully was unable to do so before Labour came to power.
St. Helier hospital is not in my constituency—it is in a Liberal Democrat constituency—but it serves half of my constituents. The health establishment has for many years scorned Mitcham and Morden. Even now, despite many complaints from me, no one who lives in my constituency is on any NHS board, either of a primary care trust or a hospital trust. So I should not have been surprised when St. Helier came under threat again more recently, when the administrators decided that they wanted to remove critical services from the hospital. It was saved only following the intervention of my right hon. Friend the Secretary of State for Health.
Those administrators argued that the site of the main hospital—the critical care hospital—was not important, as the community hospitals would take most of the people who normally go to hospitals. A public consultation was conducted, and it soon became clear that the main issue would be where to put the new critical care hospital, which would house the area's accident and emergency unit, and acute services such as maternity and obstetrics.
My view is that the people who need critical care services the most are those who are most disadvantaged and have the worst health. There is a strong link between social disadvantage and the need for emergency services and health needs such as low birth weight and teenage pregnancy. The bulk of the population live near St. Helier, and the vast majority of those with the greatest health needs live there. They are those with the lowest life expectancy, those who experience the most emergency admissions, the highest levels of child accidents, the lowest levels of good health and the most long-term illnesses. They also include those with the most babies with low birth weight, the least access to primary care, the lowest incomes and the least access to cars. The area also has the largest black and ethnic minority population. For all those reasons, I felt that having the critical care hospital at St. Helier was the best way to reduce health inequalities. The public consultation seemed to agree— [ Interruption.]
Thank you, Madam Deputy Speaker.
The public consultation seemed to agree with my views. Although fewer people from disadvantaged areas take part in public consultations, and although my own surveys were repeatedly ignored, St. Helier emerged as the top choice among the public for the location of the critical care hospital. However, last January, local NHS managers voted to overturn the views of the residents, and to build a new critical care hospital in Belmont, a very well-to-do suburb in Surrey, instead. They did so despite the fact that the health establishment initially gave St. Helier a 7 per cent. higher score than Belmont in its original assessments. That decision would have meant that St. Helier would lose its accident and emergency, maternity and other critical care services.
Belmont is one of the wealthiest areas in the country, and the people living close to it have a high life expectancy, good access to health care and high levels of private health care. The area around St. Helier has the greatest health needs in the whole catchment area, and the people living there have up to 10 years less life expectancy. They are also the least likely to have a car and the most likely to need to go to hospital. The whole catchment area can reach St. Helier well within the critical "golden hour" that our health experts agree is crucial to survival. Indeed, more people can get to St. Helier within 20 minutes than to Belmont, and St. Helier has far better public transport services than Belmont. St. Helier was the preferred choice of all the MPs in Sutton, Merton and Wandsworth, and of Sutton and Merton councils.
Given the harm that would be done in terms of health inequalities if Belmont was the location of the new critical care hospital, rather than St. Helier, Merton council called in the decision. Even the health establishment admitted that if the Belmont site was chosen, people living in seven of the 10 most deprived postcodes in the region would have to travel further than they do at the moment.
I was delighted, therefore, when the Government demonstrated once and for all to the whole NHS that health inequalities really do matter, and when the Secretary of State backed St. Helier too. She was brave to do that, because she must have been under a lot of pressure from the health establishment, and the decision must have been very close. She came down firmly on the side of reducing health inequalities. She decided that it was the patients who mattered most, and showed for all to see that reducing health inequalities was the Government's top priority.
This is the Secretary of State who has seen a fantastic growth in the NHS, a dramatic reduction in waiting times, and a significant increase in the number of staff and the amount that they are paid. She is the Secretary of State whose policies have uncovered modest overspends in some hospital trusts, and established the need for them to improve their efficiency while spending the extra money that the Government have given them. She is also the Secretary of State who has put tackling health inequalities firmly at the top of the political agenda. I back the Government's amendment.
I welcome the Minister of State, Andy Burnham—I and other hon. Members welcomed his presence on the Select Committee on Health, so I am delighted to see him in his new job. I hope that he will be able to see through this afternoon's fog to the real state of the national health service. A visitor from outer space would think that Opposition and Labour Members were talking about different health services, and I am sure that the truth is somewhere between their portrayals.
Everyone agrees that all NHS staff are striving to do their best for patients. I resent very much the suggestion that the demonstration at the Royal College of Nursing conference was orchestrated. Many people whom I have known well for years feel strongly that they cannot keep up the current quality of care. There have been instances of only one trained member of nursing staff being present on a large ward, of patients being unable to find a member of nursing staff to help them, of relatives feeding patients because there are not enough nurses to do it and of relatives looking for a doctor who does not have time to talk to them. Therefore, while there are many improvements, which I acknowledge, there are still tremendous problems.
I take that point.
The debate is about management of the NHS, so I shall refer first to reforms. In 2002-03, the Health Committee's report inquiring into foundation trusts started with a table quoted from the Journal of the Royal Society of Medicine, which listed the reforms that had taken place between 1982 and 2003 under Governments of different colours. There were 12 reorganisations between 1982 and 1997, another six between 1997 and 2003, and since then, as panic has set in, there have been at least 10 more—practice-based commissioning, payment by results, "Agenda for Change", new contracts, reorganisation of trusts, independent sector treatment centres, out-of-hours care, the computer program, the primary care White Paper and the abolition of the Commission for Patient and Public Involvement in Health. The NHS is supposed to be patient-led, but none of those has come up from the bottom; they are all top-down.
For example, by and large, independent sector treatment centres are against local wishes. I have just received a letter from one of my ex-housemen, who is now a professor of magnetic resonance imaging. In respect of independent sector scanners, he wrote:
"I am not aware of any attempt at all to evaluate whether or not the NHS could have provided this extra capacity. Many NHS MR systems are under-utilised owing to either revenue or staff shortages."
He also wrote:
"There was no consultation locally on Wave 1—it was presented as a 'fait accompli'"
In relation to primary care trust mergers, everyone in my area is against the loss of their own PCT for their own part of the county. That has been made clear at all levels, and any movement on the matter is most unlikely. I have heard other Members make similar comments this afternoon. PCT mergers are not in accordance with local wishes; they are top-down.
The abolition of the Commission for Patient and Public Involvement in Health will have a devastating effect on local forums, removing the very bodies that could communicate the patients' and public's needs and wishes. Abolishing the CPPIH two years after its institution does not strike me as good management. Equally, abolishing PCTs just two to three years after inception, just as they are beginning to work, does not seem to me to be good management.
The Government-inspired reforms, especially their number and top-down nature, lead to problems. The person who wrote the article listing the number of reforms from 1982 to 2003, quoted in the Health Committee report that I mentioned, wrote subsequently that
"perpetual reform is very costly, both in terms of the time and effort invested by managers and other NHS staff, and in terms of the financial costs of establishing the physical fabric of new organisations and of meeting the redundancy or retirement costs of displaced staff. It can create a significant diversion of time and effort from the focus on delivering improvements to patient care, and, crucially, may promote a cynical attitude to innovation and change in the NHS".
The Health Committee report on the merger of primary care trusts followed up that theme. In our summary, we wrote;
"It is clear that the impact of proposed reconfigurations on PCTs' day to day functions, including clinical services, will be substantial—it takes on average eighteen months for organisations to 'recover' after restructuring and to bring their performance back to its previous level."
"After the immediate disruption of reorganisation, it is thought to take a further 18 months for the benefits to emerge—a total of three years from the initial reforms. Thus, just as the benefits of PCTs (established in 2002) are about to be realised, the Government has decided to restructure them."
The Government attempt to justify the NHS deficits on the basis that they only affect a minority of trusts. In relation to the 2005-06 deficits, that seems to be the case. What we desperately need to know—I am pleased that the Health Committee will undertake an inquiry about this in future, as we might then find out the real scale of the deficit—is what savings all trusts across the country must make to be in balance by the end of 2006-07. That will give us some idea of the true deficit.
I have thoroughly welcomed the extra money that has gone into the NHS, but the Health Committee has heard some worrying facts about what happened to the extra £6.6 billion this year. Nearly half has gone on pay rises and other expected things, but much of the other half has gone on uncosted or inaccurately costed contracts, PFI costs, independent sector costs, the computer system and the pharmacy contract. At that stage, there has been mismanagement of the vast amount of extra money that has gone in.
With regard to the private finance initiative, would people now allow a PFI contract to be written with a clause stating that if bed occupancy goes above 90 per cent, there would be extra payment? Before the changes removing the need for some hospital beds, not all of which have taken place, as Dr. Stoate mentioned, initial PFIs were made with fewer beds. Allowing a contract to have a penalty clause for occupancy levels that would inevitably be reached was inexcusable. During one meeting of the Health Committee, we tried to find out from top civil servants how widespread the practice was. The civil servants promised to send a note because they could not answer at the time, but I think we are still waiting for that note.
There is another sad aspect of the private finance initiative. Forecasts were made of its unaffordability, and my own trust has now admitted that approximately £7 million of its deficit of nearly £30 million is owing to the PFI.
We should also ask what managers in any concern other than the health service would allow independent-sector treatment centres a fixed contract for a guaranteed number of cases, to be paid for within a fixed time regardless of whether they have been dealt with, while at the same time NHS treatment centres struggle to make ends meet? That strikes me as a little odd, and it strikes me as poor management.
Another thing that worries me, and worries many people in the NHS is who would go fast and furious down the road to privatisation when there is so much opposition from health workers of all kinds? The fact of resistance is proved by the appearance of the group called "Keep Our NHS Public", which has been joined by a good many junior doctors.
Some expenses resulting from Government rulings on top-down management seem to me fairly ridiculous. They may be controversial and I may be wrong, but I want to mention them. Clinical risk managers, for instance, are senior nurses who have been taken away from their jobs looking after patients in order to manage risk. Has there been any study of their value for money? The same question could be asked about quality managers. As for the plethora of "modern matrons", that is really just another name for the departmental nursing officers whom we have had for years and years.
The typical image of a matron is that of the archetypal figure in a smart uniform who sails around a hospital and puts the fear of death into all the nurses and doctors. That one person can do more in terms of risk, quality and the standard of care than any number of highly paid modern matrons. If I were looking for savings, rather than getting rid of practising, working nurses on the wards I would get rid of risk managers and quality managers. I would return the modern matrons to their jobs as nursing officers and bring back "the matron" who is not bothered by management or the reforms that she must introduce, but is purely and simply concerned with quality.
The hon. Gentleman's comments seem to relate to a very rigid and old-fashioned method of hospital management, which, as I am sure we all recognise, involved severe problems. Would not a more flexible approach, featuring the use of different skills by different professionals, be preferable to that?
The problem with having worked for the health service for even longer than the hon. Member for Dartford is remembering bits of it that worked and bits that did not. We have got rid of some of the bits that did not work, but one bit that did work was that leading figure, the single matron who kept an eye on all that was going on. She was far better than the modern matrons.
I am sure the hon. Gentleman agrees that it is a shame that people use the term "old-fashioned". As one who worked in the NHS as a nurse for 25 years, I remember the matronly figure with fondness, but also—and I think that this is what the hon. Gentleman is talking about—as a figure personifying visible management, standards and a climate in which patients were given the best possible care, and a figure of whom everyone was in fear as she passed.
Absolutely. Matron's ward round was seen as an event, and everything had to be just right. I think that some things in the past are worth remembering.
Another economy could be made. Every week the Health Service Journal provides two, three or four glossy brochures giving details of courses. The cost of a one-day course is £440.63, even for health service employees. That money comes from a health service fund. There are other ways of training people, and I think that the number of people we lose when they go on those terribly expensive courses is distinctly excessive.
There are many examples of the Department's making a mess of management. Perhaps there are examples of local bad management, but I wonder whether those involved have been given much of a chance. My plea is this: give the NHS a period of stability, stop the reforms for the moment and do not produce any new reforms just yet, and allow the NHS time to get into balance. It is impossible to be in balance within 12 months when some 15 per cent. of the budget must be saved.
If reconfigurations are necessary, the Government have established a mechanism to make them—politically, at least—acceptable: the independent reconfiguration panel. The case cited by Siobhain McDonagh was not referred to the panel. If it had been, it could have been seen to have been handled without political considerations.
If I were looking for savings, I would also sack some of the advisers. Prince Charles is often derided and some people do not think much of him, but some Members may recall that extracts from his diary featured in The Times on
"They then take decisions based on market research and focus groups, on the papers produced by political advisers and civil servants none of whom will have ever experienced what it is they are taking decisions about."
I consider that very significant. I should like us to get rid of a lot of political advisers, and to listen to the professionals, the patients and the public. The Government must ensure that replacements for the patient involvement forums are provided very soon, and that they have teeth and can do something. They are the very people who can help the NHS to be a genuinely patient-led service.
I will leave the last word to a retired consultant who wrote this to The Independent last Friday:
"The crisis in the NHS appears to worsen, generating the usual knee-jerk response from politicians and the media: 'reform and reorganise'."
He went on to list the major problems.
"The first", he wrote,
"is a surfeit of reforms and reorganisations. Should health care professionals introduce an untried and untested new treatment in an area of medicine of which they know little, there would be justifiable outrage. Yet ministers do this regularly without any protest other than from the professionals who have to try to cope with the resulting chaos and waste of money."
As usual, this is an interesting debate. At some points, it has featured the breaking out of an understanding across the House that all parties should be committed to the NHS. However, as I listened to the speeches of some Opposition Members, it occurred to me that they could will the ends but not the means for that understanding to grow. Conservative Members have been critical. They cannot pretend that their opposition to providing proper funding was not clear, given that they refused to vote with us to ensure that the NHS was properly funded. They said then that it should be made clear that there will be reform and value for money, and it was obvious that they were not in favour of increasing the salaries of NHS staff. During today's debate, they are saying very loudly that they support NHS staff, including doctors and nurses, but they are still critical of the increase in pay.
Pay is a significant issue. Conservative Members have talked about motivating NHS staff, but we cannot motivate them without willing the means for them to feel valued. That must include a proper salary and a proper job design and structure, which has certainly been missing for many people. A nurse can now advance her career—or his career, given that nursing is increasingly a male occupation—from a starting salary of £19,000, through grades that used not to exist, and take on management and important clinical responsibilities that used not to exist. Such a structure makes it clear to nurses that they are highly valued.
I am curious to know which professions the hon. Lady thinks are lacking in direction and focus. Does she agree that although it is perhaps right to increase NHS pay, one problem is that the increased wage bill has not been linked to an increase in productivity? So we are paying more, but not necessarily getting anything for it, the prime example being the consultants' contract.
The hon. Lady is trying to have her cake and eat it, as ever, but that is the Liberal Democrat way, is it not? It is important —[Interruption.] Mr. Stuart, who has been rather excited throughout the debate, should try to contain himself. He will doubtless get his opportunity to speak at some point. I await that with bated breath.
No, I am finishing my response to the point made by Sandra Gidley, which deserves an answer. We are entitled to expect results from consultants, but should such an expectation be included in their contract? There is a proper argument to be had about what should be included in the contract, and in my view, we should be able to demand certain outcomes from consultants. On the other hand, there are those who criticise the Government for insisting on certain outcomes. [Interruption.] The hon. Member for Romsey shakes her head. Perhaps she is not among those critics, but Conservative Members certainly have made such criticisms. They say that the medical profession should decide for itself how it operates its businesses. [Interruption.] The hon. Member for Beverley and Holderness decries my argument, but I have heard his own Front Benchers say, "Leave it to the medical profession. Free it up to do whatever it likes." That is a nonsensical approach. However, the hon. Member for Romsey made a valid point and it is worthy of consideration.
It is very important that we motivate NHS staff and show that we value the work that they do. It is disappointing that they have other issues with us, and the House will be surprised to hear that I do not entirely blame them. Their concerns are entirely understandable. As someone who had to manage change in large organisations, I entirely understand how difficult it is for people to cope with continual change, which leaves them feeling in a state of flux. We need to do more to manage change.
I am not entirely convinced by the argument of Steve Webb, who said that the problem is that change is happening too fast. Some of my constituents would cry out for more and faster change if they felt that it would benefit patients. The question should be: what will bring about the best results for patients, not for doctors or managers? These are very difficult problems to grapple with. A continually changing NHS is having to cope with new treatments coming on stream, for example. We need to balance the NHS's differing demands in a sensible way. Simply slowing down the process of change would not, of itself, be the answer.
That brings me to a very difficult problem. A lot of change is taking place in my own area. Philip Davies, who slid out of the Chamber earlier, drew the House's attention to an independent candidate who stood on a ticket of opposition to change in the NHS. Incidentally, that candidate beat a Liberal Democrat in the local elections—a point that the hon. Gentleman failed to mention. I can understand why some people say, "We don't want change in the NHS." They have grown to value the NHS and they feel that it is best left as it is—until they hear of a new treatment, which they want "today". Herceptin is a valuable example. At first, the primary care trust in my constituency refused to supply it, but after some debate about the savings to which its introduction could lead, the PCT changed its mind, and patients now have that choice.
That brings me to the question of where the balance should be struck. We have said that decisions should be made as locally as possible, yet when they are so taken—free from political interference, hopefully—do PCTs, which are charged with responsibility of consulting the public on such changes, listen sufficiently carefully? How should they then balance public demand against what clinicians tell them is best for patients? Conservative Members have put forward both sides of the argument. They have said, "Save my hospital, because I don't want anything to change", and in the very next breath said, "We ought to allow such issues to be decided locally, and we should be brave enough to shut down certain hospitals."
The truth is that both positions can be right. Some hospitals have simply outlived their usefulness. St. Luke's hospital, in my constituency, mainly cares for patients with mental health problems. Mental health treatment has changed enormously in recent years, and it is right to reconsider how we provide such care. St. Luke's has acquired a new building that is closer to the general hospital, and it could be used in a different way. The administrative facilities could be moved into that building, thereby allowing new treatments to be delivered properly in a major hospital.
For some people, a major hospital is not a pleasant experience or a good place to be. It is better for those with mental health care needs, in particular, to be treated in their own homes by a community nurse or a community psychiatric nurse. Such decisions are the appropriate ones to take, but there are more difficult and demanding ones. Sometimes, the clinical need is not clear, and the community take a different view on what should be delivered from that taken by the PCT, the hospital trust or even the Member of Parliament. [Interruption.] I see that the hon. Member for Shipley has returned to his place, and I am very glad that he is here. When he stood against me in 2001, I enjoyed his company greatly. I also enjoyed it when he stood for election to the local council, and I am sorry to have to tell him that his friend, who stood and won, has now lost her seat. I am grateful to him for bringing to the House's attention the fate of his own party and of the Liberal Democrats.
The independent candidate to whom I referred earlier won her seat fighting on a ticket of opposition to NHS cuts. It is easy to utter slogans about health, but it is not a responsible thing to do. [Interruption.] Conservative Members laugh, which may sound fine in a debate, but it is not a very sensible attitude to take. If we are to make proper decisions about local health care, we have to accept that those decisions will sometimes be difficult and that sometimes the public need to be listened to. Part of the argument about hospital reconfiguration in my constituency—which needed more care in the decision making—concerned maternity services. The hon. Member for Romsey and I have discussed the issue in the Chamber before. The way in which maternity services can be delivered is changing and that should be part of a plan, but it should not be the only plan.
The difference between maternity services and, for example, mental health care, orthopaedic care, heart surgery or cancer treatment is that all those expecting a baby hope and expect that their experience will be normal and a family event. They do not necessarily consider it as a health intervention. In fact, it would be a bad thing if they did. Birth should be as ordinary and as happy an experience as possible.
I agree with the hon. Lady. It is important that maternity services are midwife-led and available in community hospitals. Given that that is the case, why have the Government closed the midwife-led maternity units in Malmesbury, Devizes and Trowbridge? Such units have been closed in seven hospitals across Wiltshire, so that the only places to have a baby are Bath and Swindon.
In fact, my community disagrees with the PCT. The community wants an ordinary maternity unit in the local hospital and does not want a midwife-led unit, so we are on opposite sides of the argument. My personal view is that midwife-led units can, in the right circumstances and with the right support, be of great benefit. Midwives are the right people to make decisions and help a mother through all prenatal care, the delivery of the baby and some of the postnatal care. The relationship that can be built up over a period of time is valuable to a safe birth and important in helping mothers to take decisions that lead them away from unnecessary interventions, such as elective caesareans. As soon as a pregnant woman visits the local maternity unit, she sees shiny pieces of equipment and thinks, "Oh my God, I need some of that. It is bound to all go wrong and I want to ensure that I am as near to that equipment as possible." That has been the undercurrent of the debate on health.
Some people in the community claim that the issue is cuts in public spending on health, but nothing could be further from the truth. In fact, the argument started five years ago when the health authority took a decision against the advice of the hospital, which wanted to move maternity services into one huge unit—a sort of super maternity unit. We rejected those plans, although the hospital claimed at the time that it was a matter of clinical need. Dr. Taylor has mentioned clinical need, but the problem is that clinical decisions are not always straightforward. Clinicians argue about them all the time. Indeed, clinicians from all over the country came to my constituency to argue about the best way forward for delivering babies. There is not only one point of view or one way of delivering excellence. That is fine, if the community backs the eventual decision. If everybody in my community demanded a midwife-led unit, I would not blame them for doing so, because it could be an excellent move. However, if it were introduced against the wishes of the community, we would have a problem, because it would be set up to fail —[ Interruption. ] Dr. Murrison laughs, but—
It is not a bizarre argument, because we would be introducing a service for a public who do not want it. Does the hon. Gentleman really expect that a young mother would decide not to go to a hospital where she could get all the intervention that she thinks she might require and that she has become used to over the years? My constituency has one of the lowest rates of home births. It is not the norm for mothers there to elect to have that form of delivery, nor is it the norm for them to consider midwife-led units. If such a unit is set up without a proper explanation of how it can benefit mothers and without proper support, does the hon. Gentleman think that they will elect to go there?
The hon. Lady obviously has not listened to my hon. Friend Mr. Gray, who argues in favour of midwife-led maternity units. In my constituency, as in his, such units are being closed, and there are huge ructions in the community as a result. That is probably what she is trying to say and, if so, we may have found a point of agreement.
The hon. Gentleman misunderstands. I am saying that there is not only one way of delivering maternity services, nor is there only one public view on them.
I accept that, and my constituents want the choice. However, they do not want the option that is being presented to them, after a lengthy consultation, by the PCT. The PCT received a petition with 50,000 signatures and 2,000 postcards from my constituents—the proposal covers three constituencies—and a different petition with 30,000 names. Despite that, it came to its bizarre conclusion because the clinicians thought that the best way forward was to separate out maternity services, send potentially difficult cases to another hospital in a different town and have only a midwife-led unit in Huddersfield. The community said, properly, that it was used to what it already had and did not buy into the PCT's suggestion. Mr. Gray said that his constituents value their midwife-led unit, but my constituents do not yet agree with him. They demand the choice, and perhaps that is where we agree.
The hon. Lady is doing a masterful job in making up for the shortage of Labour Members wishing to speak, so I am sorry to encourage her further. However, she is missing the point entirely. Seven hospitals across Wiltshire are being closed and there will be no choice for mothers. The units will not be midwife-led or use any other system, because her Government are closing those hospitals. Why?
The hon. Gentleman needs to think again about how he presents his argument —[ Laughter. ] Well, Opposition Members laugh, but they are misrepresenting the case. It is the primary care trusts who are charged with the task of consulting the hospital trusts and making the decisions. It was a clear decision by the Government that such decisions should be made locally, and that is where the next dichotomy arises. The community in my area want one thing, but the PCT and the hospital trust have come to a different conclusion. I want decisions to be taken locally that take account of the community's views. Where do we go from there? Well, we go to the Secretary of State, who then acts as an arbiter.
My personal view is that we should have an independent inquiry into the issue. PCTs must take their responsibility for their communities seriously. They are charged with the duty of consulting properly. In this case, no fewer than 100,000 people—assuming that people signed only one of the petitions—made their views known, and if the PCT does not take account of that, it should look closely at the way in which it makes decisions —[ Interruption. ] Opposition Members are giggling and perhaps they will share the joke with the House when they make their own contributions. Why do Opposition Members think that it is funny that I want to champion the cause of my community, which has had a dreadful experience with a consultation with the PCT?
I have had several meetings, and a debate in Westminster Hall, about this matter. I am unhappy that my constituents will not get the service that they are demanding, but also at issue are important questions about how we set up the local delivery of health services. How do we charge PCTs with the task of making sure that those services are what is wanted by the people who, through their taxes, pay their wages? That should be a simple question for Opposition Members to understand, but ensuring that we have a democratic NHS might be too difficult for them.
The hon. Member for Wyre Forest said that clinicians were the only people who should take such decisions, and that the balance must lie somewhere between the outrage exhibited by Opposition Members on the one hand and that expressed by Labour Members on the other. He may be right about that, but arguments about the local delivery of the NHS should not cause us to blame the Government for local decisions, nor to do the opposite—that is, scurry back to the Government about every local decision that we do not like.
The argument is difficult, but there is one matter about which I agree with Opposition Members, so perhaps they should not giggle quite so much. The hospital trust in my area is being reconfigured, but changes in the PCT are also being considered, as I shall explain.
The PCTs have more money to spend in our communities than ever before, and they control huge budgets for the delivery of community services to our constituents. That is valid and valuable but, when PCTs were being set up, I argued fiercely that they should be as local as possible. I was very glad that it was decided that my PCT should be very small, as my community is very different from the ones that surround it. I thought it important that my constituents' views about how their money is spent on their health services should be taken properly into account, and I still do.
My right hon. Friend Mr. Barron spoke about health inequalities. The inequalities that exist between my constituency and that of my hon. Friend Mr. Sheerman are very stark. Given that PCTs are being reviewed, it is important that the proposed new structures are looked at.
I have made a counter-proposal and I hope that the Government will listen to it. It should be clear to the House that I place great value on giving people in the community a say in how the NHS is run. I understand why a bigger PCT could deliver better value for money, and why bigger management teams could be slimmed down. However, I fear that that approach could cause us to lose something that I value very much—community involvement in the NHS. The House may not value that as much as I do, but I believe that that is how we can make sure that what is delivered is in the best interests of my community.
My proposal is that we look at how we can build a smaller, locality-based form of PCT into the overarching management committee that covers a number of PCTs. I have discussed the idea at length with my right hon. Friend the Secretary of State and other Ministers. The advantage would be that funding for each area could be ring fenced and so deal in part with the problem raised by my right hon. Friend the Member for Rother Valley. That is, people in richer areas would not be able to raid the funds of the poorer areas.
There is a huge difference in how the two PCTs in my area are funded. The per capita funding has been greatly reduced for people living in areas where health inequalities have had less impact, whereas it has been greatly improved for the poorest people. That has to be right, but my fear is that a much larger PCT would have an adverse effect on the management of health inequalities.
Such problems matter. If we do not think about patients' experience of the NHS, value what they say about what they want and stop the richest raiding the funds of the poorest, how can those who need the most get what they need? I hope that Ministers and the Secretary of State will look carefully at the proposals for the Kirklees PCT, and the proposals that I have made about making the best use of resources. I accept that an over-arching executive board would be cheaper than having three separate boards, but we must retain the important and valuable role played by non-executive board members. Their work as advocates for their local communities will mean that, when future consultations are held about the provision of health services in my area, people can be assured that they will get value for money and the health service that they crave.
It seems an eternity since this debate began. It is customary in such debates for Opposition Members to identify problems and blame the Government for them, and for the Government to identify successes and take the credit; for the Government to gloss over problems, and for the Opposition to ignore the successes; and for the cup to be seen as half empty by one side, and as half full by the other. What is missing is the perception that successes and failures are often intimately related.
I want to return to the substance of the debate. I have no reason to believe that civil servants or Ministers in the Department of Health are any stupider, less efficient or less caring than their counterparts elsewhere—at least I hope that they are not. I think that the fault lies with a mistaken ideology based on flawed thinking and a false prospectus. I am sorry to say that that ideology seems to be shared by ranks of dubious advisers and think tanks, as well as the official Opposition and, sadly, the Prime Minister. That is what the Department of Health and Ministers have to contend with.
That false ideology is at the root of the problem, and it is possible that it will be the cause of this Government's ultimate downfall. It is an ideology dreamed up by people who do not understand what the NHS is. As I understand it, the NHS is the vehicle by which we—the healthy, the taxpayers—entitle the sick and infirm to a standard of care that they simply could not afford by themselves. The NHS is a provider of entitlements and a moral enterprise. It is not a business, but nor is it a fairy godmother to satisfy every whim and ill.
However, just as the sick are entitled to care, so the taxpayer is entitled to value for money, and to see that the money invested is well spent. We all welcome the new investment, and we all want value for money, which leads us to the mantra about investment and reform that the Government recite again and again—although the word "reform" should be a synonym for beneficial change, and not just for change itself. Moreover, not every change is a reform, and there is certainly something wrong with permanent reform that is too fast and too frequent, and which is ill-managed and incapable of being withstood by the organisation to which it is applied. That is what is called chaos.
Mao Tse Tung thought that revolution was a good thing, but discovered eventually that permanent revolution was not such a good thing, as it led to destitution and chaos. We have almost got to that stage in the NHS, caused by well-motivated but mistaken attempts to secure value for money.
In the early phase of this Government we had a target and inspection regime that in itself was not bad: setting targets and having inspections is one way to encourage a degree of efficiency in a public service. Gradually, however, it was recognised that the service could be distorted by performance indicators that caused silly things to be done, such as taking the wheels off trolleys so that they could be called beds. Moreover, targets could be politically driven. They were micromanaged and run to satisfy inspectors, and they were neither sufficiently focused nor alert enough to patients' needs or clinical priorities.
That approach has not been abandoned altogether: it is still around, being implicit in the contracts for dentists and GPs whereby activity is to be rewarded. In some ways the process has become more sophisticated and works a little more harmlessly than in the past. Now we simply have a new, more dominant model of reform; in the absence of another description I shall call it the market model. It seems to be widely accepted on both sides of the House, although not by me, and consists of turning our NHS institutions into autonomous trading units, increasing competition and importing concepts of consumer choice from private enterprise. Its rationale is relatively easy to understand: such models are supposed to encourage efficiency in the private sector, so, it is argued, they will necessarily encourage it in the public sector. It is believed that the model will eventually shake out waste and inefficiency in the NHS, which of course we are all against.
There are fears about the model, however. The fear that it will accentuate health inequality has been voiced in the debate. There is also the fear that the model will bring unpredictability, and the fear, which should dog Labour Members, that it will bring the collapse of much-needed services and district general hospitals. The reason for those fear is that markets do not deliver entitlements, and the NHS is not a market.
To deliver the complex entitlements that the NHS offers, it needs to operate seamlessly. There must be strong clinical networks spanning many agencies, co-operating and not trading with one another. The NHS needs strong partnership arrangements and good integration. I offer a practical example from my own neck of the woods, where there have been long-standing problems with children's services, which were to be ameliorated, in part, by co-operation between Alder Hey, the PCT and the acute trust to establish good and better clinical networks. That clinical network—the solution—has been blown apart, because the organisations concerned have acute individual financial needs and problems that they need to address separately rather than co-operatively.
I have another example. My local GPs have told me that they want to work co-operatively, to co-provide and fund new secondary care facilities, but they dare not because there are so many uncertainties about the effects of the choose and book system. The GPs might set up something for which there turned out to be no predictable demand, so their investment would go to waste.
Even if we concede that there is any merit in that dotty market model—and I do not think that we should—we must admit that the NHS is a strange marketplace. After all, what market has its costs and tariffs invented, varied, tweaked and tweaked again by civil servants on an irregular and unpredictable basis? What market rewards providers in one area more than in another, not by market circumstances but by Government decree? I am referring to the market forces factor, which may be subject to considerable debate at a later stage. What business—whether Tesco or any other—forces its newer branches, as the NHS forces hospitals, to bear the capital costs of newer buildings, so that it costs more to treat people in newer hospitals, which trade at a loss and are then charged 10 per cent. on their overdraft? The word "trade" is horrible in this context, but we are forced to use it.
That is the situation in my local hospital. It has new buildings and good clinical outcomes. It has a deficit, but it is cursed by the strange way in which capital charges weigh on it, and by dotty perverse solutions dreamt up by accountants who can see only financial solutions rather than clinical ones.
The hon. Gentleman is answering his own question when he asks what sort of market and competition the NHS is. It is clearly not a private sector market with private sector competition, so his parallels do not seem to be taking him anywhere. Is he really saying that choice is such a bad thing, and that if an elderly lady were offered a hip operation either in her local hospital or in a hospital near where her daughter lives, she should not be allowed to choose the latter?
I am saying that the fundamental job of the NHS, as established by Aneurin Bevan, Beveridge and so on, is to deliver entitlements. People are entitled to a degree of choice, but entitlement must come first. If the choice regime leads to things being unavailable that were previously available, entitlements are lost and disappear.
At present, we have a strange, perverse, hybrid market; we have a muddle, with mixed messages from the Government. Worse still, there is the potential for mayhem—that should put fear into Labour Members. It is not too late for the Department of Health to turn round and be sensibly pragmatic, which we will all support; to consult and inspire the NHS work force, which it has clearly failed to do so far; to proceed on an evidence-led basis, which it has not done so far; and to listen. But that would mean the Department of Health and the Labour party taking on the crazed ideologues who buzz around No. 10. Not to fight that battle is, ultimately, to betray the NHS, and the nation.
I shall try to be brief, partly because I feel a bit peckish and partly because quite a few Members want to speak.
The topic for debate is the management of the NHS by the Department of Health. Thank goodness the NHS is managed not by private business, as the Opposition would prefer, but by the Department of Health. I am not a dinosaur and I have no problem about the use of spare capacity in private hospitals. Philip Davies will know what I am talking about, because the Yorkshire Clinic is near my house. The clinic is pleasant and I have attended it from time to time for minor diagnostic procedures, paid for by my health centre because my appointments were for 8 o'clock on Sunday mornings. I did not mind that, because my treatment took place at times when the clinic would otherwise have been unused.
In the main, however, acute health provision must remain free at the point of use for all and—dare I say it?—from cradle to grave, as is the case at the wonderful Airedale general hospital at Eastburn in my constituency. Airedale hospital is the biggest employer in my constituency; it is much loved and appreciated by patients from Settle in the north to Bingley in the south.
The hon. Lady says that NHS care should be free at the point of delivery from cradle to grave. Would she include dentistry in that?
Yes, I certainly would.
Airedale hospital also serves Pendle on the other side of the Pennines, the constituency of my hon. Friend Mr. Prentice, as well as the leafy suburbs of Leeds in the east, including magnificent Ilkley, and its moor, in my constituency. The air ambulance helicopter is crucial for carrying patients, including potholers, climbers and walkers in the dales, to Airedale's accident and emergency department. It is a hugely popular and life-saving facility. However, I live in Shipley, four miles outside my Keighley constituency, in the constituency of the hon. Member for Shipley, so I am in the catchment area for the Bradford Royal infirmary, which I use, but I want to describe various aspects of the NHS that I know something about.
Following the death of my second husband, John, from cancer 18 months ago, I appreciate the choices available for cancer patients. John could choose from ward 15, the oncology ward at the BRI; palliative care at home, with the support of the hospice at home team; or hospice care at Sue Ryder Manorlands at Oxenhope in my constituency or the Marie Curie hospice in Bradford. It was extremely important for our family to be able to discuss, around John's bed, how we should choose palliative care for the end of his life. It was a very positive experience.
I shall soon be an in-patient at the BRI. Being a coward, I am not looking forward to the experience one bit, but at least I know that when I go into hospital it is for necessary surgery, not because a gynaecologist wants to make money out of me. I do not have to think about how many bits of cotton wool will be used, and I do not have to worry about something going wrong. I know that if it did, I would be transferred to another part of the hospital for appropriate treatment.
On the subject of dentists and other things, I have two moans: yes, there are not enough NHS dentists, and yes, there are too many changes in the NHS. So let us now concentrate, consolidate and stop change for the sake of change. I want to mention to my hon. Friend the Minister—I wonder whether he will touch on this—that there are possibly too many elderly people, and I consider myself to be one of them, at 66, but I am not sure what we do about it. It is wonderful that we are living longer, but we must consider a bit more carefully where we will go when we get to the point of needing help.
On the subject of the elderly and where we should put them—I think that that was the point that the hon. Lady was just getting to—I hope that she will agree that what should not happen to the elderly and some of the most vulnerable in our society, the mentally ill, is what happened yesterday as a result of the decision made by Shropshire County PCT to close, at Ludlow community hospital, the only ward for the elderly mentally infirm available in my entire constituency, as a direct result of financial cuts. There is no clinical or patient need to close it, because the patients will be transferred to the only remaining Victorian asylum operating in England. The decision was taken purely for financial reasons—the result of the Government's mismanagement of the NHS.
Perhaps my hon. Friend the Minister will address the hon. Gentleman's comments, but I cannot; I do not know anything about it. Of course, yes, we must consider the care of the elderly very carefully.
My auntie died in January—it was just awful for me—and we discovered from the post mortem examination that she had a calcified broken femur. She was in a residential home. Why did that broken femur go undiagnosed? I could not understand why she was in pain. We found out why on her death. The cause was that undiagnosed broken femur. The residential homes that are looking after elderly people are frequently not up to the job.
I am not sure whether that would answer the problem that I am talking about. My auntie was receiving free care, because her savings had gone down to a certain limit. I understand what my hon. Friend is talking about, but it would not have helped. I am concerned that the care must be adequate. Whether free at the point of use, or whatever, the care should be adequate.
Finally, I have been promised by the Department that the Coronation hospital at Ilkley in my constituency will not close until the services that it provides are up and running at the Springs medical centre next door. That is what I have been promised, and it is what I expect. I hope that my hon. Friend the Minister will comment on that.
It has been an extremely interesting afternoon, not only with hon. Members sliding in and out, but with unanswered questions about what we do with elderly people—as I am approaching that place myself, I will give it some thought.
I should like to thank some hon. Members for their contributions—in particular, my hon. Friend Mr. Swayne, who is not present now, and the hon. Members for Wyre Forest (Dr. Taylor) and for Dartford (Dr. Stoate), all of whom made thought-provoking contributions.
Of course, I include Mrs. Cryer.
I do not think that the staff have had much mention today, and in my constituency—Guildford—generally speaking, patients are getting an incredible standard of care, kindness and attention from an extraordinarily hard-working work force, whom we talk about in the House often without recalling that they are at the front line, delivering care. I know that there are problems in some instances, but their dedication and commitment are outstanding, and the one thing that they would always ask of us is to try to keep the use of the NHS as a political football down to a minimum. Many hon. Members have welcomed those of this evening's contributions that have been thought-provoking and considered some of the not easy issues that we must consider.
I am sure that the hon. Lady's generous remarks about NHS staff will be appreciated throughout the country. Does she agree and will she put it on record that NHS staff get a much fairer deal on pay under this Government than they did under the previous one?
I thank the hon. Gentleman. That is just what I have been talking about: it is all too easy to say, "Well, five, 10, 15 or 20 years ago, it was so much worse." That is what NHS staff do not want us to talk about; they want sensible contributions. Of course, pay has gone up—so it jolly well should—but there are issues that we must address. In 1996, pay had gone up from 1994, and so it goes back. What the public and staff are looking for are sensible contributions, and I should like to talk a little bit about what is happening in my constituency.
My hon. Friend the Member for New Forest, West talked about perceptions. If nothing else this evening, I hope that we can bring Members on both sides of the House together, at least to recognise that what is happening in our own constituencies is not necessarily the same as what is happening in those represented by other hon. Members. Certainly, the bigger picture for Guildford and Waverley PCT is looking rather grim.
The PCT had a substantial and partly inherited deficit. Last week, to alleviate that deficit, it decided, against public opinion, to close community beds. It took that decision after many months of consultation and many hours of work by the local community. The PCT decided to close Milford hospital, which, although not in my constituency, is used by many of my constituents and is a specialist rehabilitation centre. It also decided to close beds at Cranleigh village hospital. That was one of five options that the PCT had to consider. Democracy and local opinion have been mentioned, and it is of note that 94 per cent. of local people did not want that option.
The decision was taken despite the fact that the local community in Cranleigh has raised considerable funds to rebuild Cranleigh village hospital. It was taken despite the fact that the Cranleigh village hospital trust has now been given a piece of land on which to build the hospital and despite the fact that it has planning permission to build the hospital and a partner within the project. In fact, the trust was going to build precisely what the Government would like to see: a community hospital that has flexible space, the opportunity for step-up or step-down beds and the space to perform diagnostics within the community.
By pulling the plug on the beds at Cranleigh village hospital, the PCT has put the project in jeopardy. The partners are unsure whether there is any real commitment from the NHS to buy services from the hospital. It is extremely disappointing to local residents in Cranleigh that the Government cannot see that. I share the frustration of my hon. Friend Mr. Paterson, who said that he has written to the Secretary of State and to Ministers but nobody is listening. There are exceptional circumstances—Cranleigh village hospital is one—where the community have embraced some of the changes that the Government would like to see and have raised all the funds to build a new hospital, but still it seems impossible to get the attention of Ministers or the Secretary of State.
The problems have just started in the Royal Surrey County Hospital NHS Trust in my constituency, despite the fact that it has done so well on many fronts—in fact, the chief executive did so well that I understand he has moved on to greater things and is now the principal policy adviser to the Secretary of State. Having been in balance, the trust is now forecasting a £15 million overspend and today it announced plans to try to counter that. I have had some reassurance that the situation is unlikely to lead to redundancies at this stage, although I think that there will be some job losses.
Mr. Barron said that the public sector can sometimes be rather self-serving. I know what he is talking about and I note his comments. I remember a time when I worked in the NHS, when the first aim and objective of many public sector workers was their pay and conditions of service. Their second objective was service delivery. That was in the '70s and I remember it well. I do not believe that that is the case now or that the Royal College of Nursing did what it did the other week—or is coming here to do on Thursday—because those people are self-serving and are simply thinking of their own jobs. People are behaving like that because they are frustrated and because they do not feel that the Government are listening.
The hon. Lady will remember from when she worked in the national health service that, when the pay review body was set up, for seven out of 10 years her party implemented a staged pay rise. That has not happened under this Government.
My problem is that I was not a Member of Parliament then. I remember what it felt like in the NHS and perhaps it is of note that it was because of my experience in the NHS that I went into politics—and I am on the Conservative, not the Labour Benches. There is a reason I joined the Conservative party and not the Labour party and if Labour Members really want me to go back and describe the situation in the NHS when I was a nurse, I will gladly tell them about it. When I could not get a porter to take a patient to the ward and wheeled him myself, the porters went on strike for 24 hours because I was doing their job. We can all go back, but, as I said earlier, it is important that we look ahead.
The situation for my constituents in Guildford feels rather grim. We have a review of acute services in Surrey and while we would welcome many of the changes that the Government are talking about and that the hon. Member for Dartford mentioned, maternity services, paediatrics, and accident and emergency at the Royal Surrey county hospital are all going to be under threat. The problem is that, on the one hand, the Government talk about delivering services more locally and closer to people's homes and, on the other hand, they talk about reviewing acute services and moving such things further from people.
I admit to a certain amount of confusion and we have heard a confused story this afternoon and this evening. A lot of Conservative Members have talked about community hospitals and midwife-led units closing, while some Labour Members have told us how wonderful the NHS is. My constituents have been refused PET scans and DAT scans, and even a hernia operation, because the PCT is not buying them any more, on the grounds of cost. The hospital says that the PCT will not pay for them and the PCT says that it has funded them, but the patients are left terribly confused and do not know who is making the decision. The NHS about which some Labour Members talk is not the NHS that I recognise at the moment in Guildford. The situation is not all bad, but there are serious problems and we are finding that our services are being cut.
The headlines that we have seen in the papers recently are not just made up. Such headlines include "10,000 nurses 'can't find a job' in cash-strapped NHS" and "Treatment centre programme in disarray as contacts axed". The hon. Member for Wyre Forest talked about that problem earlier. The new independent sector treatment centres are being paid whether they do work or not. They are coining in the money, but are operating at about 50 per cent. They get the money even if they do not do the work. Other headlines include "How NHS cash goes to waste on private ops", "NHS 'facing worst financial crisis'", "Threat to funds for medical training as hospital advertises for four risk assessment managers" and "NHS faces job cuts as financial crisis deepens". Those stories are not made up.
I urge hon. Members on both sides of the House not to dismiss contributions from Conservative Members as political posturing. I also urge Conservative Members to consider what they have heard from Labour Members. We have to find a solution. I know that I need to protect and look after my constituents and that they need and deserve a better NHS than they are getting at the moment. It would be becoming of all of us to look ahead and find real solutions to some of the problems.
Thank you, Mr. Deputy Speaker, for calling me to speak in this important debate.
I am surprised by the choice of subject for this Opposition day. I seem to remember that a previous Opposition day was dedicated to welfare reform. Today, the Conservatives have once again been kind enough to choose a subject for debate on which we have led the way since 1997. I thank Conservative Members for giving us the opportunity to celebrate our successes.
Since 1997, we have doubled investment in the NHS, and by 2008 we will have trebled it. Waiting lists are at their lowest ever. No one now waits more than six months for an operation and no one with suspected cancer waits more than two weeks to see a specialist from the day that their GP refers them.
The hospital that serves my constituency of North-East Derbyshire, the Chesterfield Royal hospital, is beating those national statistics. The national standard for a first routine out-patient appointment is 13 weeks. At Chesterfield, a patient waits a maximum of 10 weeks, although most people do not have to wait even that long. That success is largely due to a close working relationship between our primary care trust and the hospital to ensure that waiting times are some of the lowest in the country. By the end of March last year, every single patient who was referred with suspected angina was seen within two weeks. Every single patient with suspected cancer saw a cancer specialist within two weeks, and every single patient diagnosed with cancer was treated within one month. Anne Milton was absolutely right that this is not about politics or point scoring. What we have been doing since 1997 means that more people's lives are being saved.
I make no apology for being parochial. The successes and changes that we have seen in North-East Derbyshire have been astonishing, but what is most significant is the massive cultural shift that we have seen in the health service in empowering patients. From direct personal experience, I can say that the shift in emphasis to put the patient at the heart of the NHS has been our greatest success.
I have recently had two children at Chesterfield Royal hospital. The first baby was born five weeks prematurely and had to spend 10 days in the special care unit. I cannot speak highly enough of the nursing staff and the doctors. It was our first baby. It was a terrifying experience. By informing us and involving us in every decision made, we knew exactly what was going on and what to expect.
I recently met the North-East Derbyshire patient and public involvement forum. If it is anything to go by, the voice of the patient is being heard loud and clear. This and other such forums were set up three years ago to provide a local voice for the community on health matters. They are independent of the NHS and it is the Appointments Commission that has responsibility for appointing members to the forum.
I know what the hon. Gentleman is about to say. However, I shall complete my point.
The task of the forums is to gather views about the quality of service, to monitor the gaps and provisions and to make suggestions on improving services. They regularly meet the chief executive of the North-East Derbyshire primary care trust—a relationship that needs strengthening. I hope that the forums will become better resourced and will be a focal point in the health service, whatever their name is in future. They will do that by putting patients at the heart of the NHS. I would like some reassurances from the Minister that they will be able to continue to do their good work.
I had a similarly excellent experience—it was not quite the same as that of the hon. Lady's—with my wife at St. Paul's Cheltenham maternity wing. Sadly, it has been closed under the current financial cuts. The hon. Lady talks about patient involvement and a patient-centred NHS. Has she noted the comments by a governor who has resigned from the acute trust in Cheltenham. He said:
"I was elected to represent the people of Cheltenham, but if no one takes any notice then it is quite useless. I am not going to be some sort of window dressing."
There is the recent resignation of the patient and public involvement representative on the primary care trust. There are the 13 governors of the acute trust—