I shall be brief, because much of my thunder has been stolen by Mr. Prentice. I could not better his critique of what is going wrong in the health service.
The main focus of the debate is on NHS planning, or the lack of it. NHS planning is in danger of becoming an oxymoron, like "journalistic balance". Although it is not my habit, I can best illustrate that point using events in my constituency, where we have the usual litany of modern NHS ills, especially in the acute sector. Only this week, we had another ward closure; this summer, we had ward closures, cutbacks and redundancies, not only among support staff, but on the clinical side. All year there has been anxiety about deficits and disputes about their cause and the solution to them. We have seen plenty of management consultants, plenty of hassle and plenty of controversy. Despite all that controversy and hassle, the staff have got on and delivered an exemplary service, but the word "planning" has no place in their world that they can understand. One can plan only when one properly understands the environment in which one is working, and there is no evidence over the past 10 years in my constituency that anybody has been able to do that.
Ten years ago my local trust, which controls two hospitals, tried to deliver a plan—not a very good plan, but it was based on allegedly clinical criteria. It was based on the demands of the medical profession for safety, clinical standards, training capacity and so on. It was deeply flawed. It had children who had suffered any kind of trauma or accident by-passing a fully fledged casualty department, and it was not acceptable to the people of my constituency. It was supposedly and unconvincingly based on the latest recommendations from the royal colleges, but it was at least coupled with a substantial new build investment programme.
However, even before the quoted medical advice had changed and before the plans were allowed to settle down, they were all thrown into the melting pot by the unexpected implications of junior doctors' hours and changed conditions and the European working time directive, none of which hospital managers could do a great deal about. Just as that was heading for a settled outcome, payment by results appeared on the radar, ushering in uncertainty and further turmoil. Management consultants then proposed clinically absurd proposals at variance with all the previous proposals, and the new capital investment under payment by results became a financial millstone. The accountants—McKinsey's, Ernst and Young and the rest—rather than the doctors appeared to be calling the shots.
That was not planning. It was reactive. It was crisis management. It is crisis management, but each crisis is internally generated. The public are left baffled and angry and the politics is messy and at times unpleasant. At the height of all this, there was a blessed moment of sanity in my constituency. The primary care trust, backed by the strategic health authority, took matters in hand, called all the parties together, sat them down and asked simply, "What do people here need? What can people fairly expect to receive?" Genuine consultation took place and for a time real solutions seemed to be in the offing. It was a model of crisis resolution.
Clinical networks were planned, sensible co-operation between all parts of the local NHS was envisaged, including specialist hospitals such as Alder Hey, and a genuinely workable road map was worked out, but then it all got parked. The PCT was abolished, the strategic health authority was abolished, the plans were sidelined, clinical networks were dropped and people were moved on. New financial goals were set overnight, management consultants from outside came in again, politics intruded again and the local NHS was turned upside down again. Financial considerations seemed to dominate over clinical delivery.
Like most trusts in the NHS Confederation, my trust is reciting the current mantra that so many beds and so many nursing staff may not be necessary. People cite figures showing the considerable fall in hospital occupancy over the past decade. However, they omit to tell us that the number of acute beds, as opposed to beds for maternity and the elderly infirm, has not fallen appreciably. We get flimsy clinical excuses for financially based decisions. Looking on anxiously in almost every constituency are the poor public—the citizen, whether ill or well—unable to detect the shape of future services, unsure of what awaits them, and unconvinced of the existence of even a Baldrick-like cunning plan.
As I look back over the past decade, I can detect periods when the concerns of doctors were dominant, periods when the interests of hospital administrators were dominant, and times such as the present when the voice of the accountant and the management consultant is dominant, but I have yet to experience a period in which the voice of the community and the patient is dominant, and I have yet to see an argument against it.