Health Care (Suffolk)

– in the House of Commons at 5:15 pm on 19th October 2006.

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Motion made, and Question proposed, That this House do now adjourn. —[Mr. Heppell.]

Photo of John Gummer John Gummer Conservative, Suffolk Coastal 5:17 pm, 19th October 2006

I wish to discuss national health service provision in Suffolk as a whole, and in my constituency of Suffolk, Coastal, in particular. I begin by making two points to the Minister. First, I recognise that additional funds have been put into the national health service—indeed, I not only recognise the fact, but support it. Secondly, I recognise his good faith and the fact that he has shown competence and directness in handling the issues of the national health service since he took over the job. For that reason, I hope that he will not take some of the hard things that I will say personally, or as a comment on what is happening across the country.

My case is that Suffolk has particular problems that are clearly not of our own making, or the making of the people whom the Government have put in charge of our national health service. The key figures are simple. In the pecking order of 304 primary care trusts that, until recently, were in operation, Suffolk Coastal was 210th, receiving 91.5p against a standardised average of 100p. However, if we look at the number of over-65s in the 646 UK constituencies, we see that my constituency ranks 16th. My Suffolk, Coastal constituency and Suffolk Coastal PCT are not entirely coterminous but, to all intents and purposes, that is a perfectly reasonable comparator. As age is the biggest determinant of need in the health service, one would expect a rough correlation between areas with a higher proportion of old people—22 per cent. of my constituents are over 65, many of them are very old indeed, and a high proportion live in single-person households—and areas where the NHS receives an above-average sum from central Government.

The correlation would not be exact, as there are other issues to take into account, but there is a serious mismatch between my constituency, which is ranked 16th of 646 constituencies, and the PCT, which is ranked 210th of 304. That is neither right nor sensible. The fundamental problem is not one of spending but of under-resourcing. The way in which the Government hand out money makes it impossible to provide even an average service, as we receive less than average per head. The figures are even tougher for Suffolk as a whole, as the county receives 82 per cent. of the average funding, even though the average age of the people who live there is at the upper end of the spectrum.

The Government's own quango, the Countryside Agency, which is responsible for dealing with the countryside, has pointed out that rural provision costs 70 per cent. more than urban provision. The cost of health cover in rural areas is 74 per cent. greater than it is in most urban areas. As the area is almost entirely rural, the funding arrangement is not sensible. On the Government's own figures, it ought to receive a higher than average sum, not a below average sum. It is not just one PCT or one hospital that has overspent its budget over many years but every PCT and hospital.

To misquote Lady Bracknell, for one PCT to overspend might be thought an accident but for every PCT and hospital to overspend must be considered carelessness. The question is, whose carelessness? It is not, I submit, the carelessness of the heterogeneous collection of people appointed by the Government to run our local services—it is the Government's carelessness in a number of specific instances. The amount of money accorded to those institutions is unsatisfactory. Every indicator suggests that we should receive more than average, but the Government have decided to give us less than average. Every indicator suggests that it is more difficult to provide services in that part of the country, but the Government have decided that it should receive less than other areas.

Everybody knows that old age is the major indication of need for help by the national health service, but the Government have decided that it is not suitable as a proper reflection of the situation when it comes to deciding what the resources shall be. They have changed the way in which they measure by reference to a deprivation index. I am all in favour of that, except that that it is what is necessary for a preventive health service, yet we have an acute health service. Perhaps the Minister would like to have something different, but that is what it is. That means that we have to try to determine the real measure of the need for acute services: again, it is age that really matters.

So who is being careless? First, the Government are being careless because their method of sharing out the money detracts from the ability of anyone in Suffolk to deliver the service that should be delivered. Secondly, the people whom the Government have put in charge are being careless. I do not know what the strategic health authorities do for their money. When one asks them whether their purpose is to represent to the Government the needs of their areas, they say no—that is down to Ministers. If one asks them whether it is to keep the PCTs within their spending limits, they say no—that is down to the PCTs. When we ask Ministers what their purpose is, they tell us that they are supposed to keep the local PCTs, hospital trusts and the like within their spending limits. Why the blazes, then, was the PCT overspending with no reference to the strategic health authority?

Photo of David Ruffley David Ruffley Shadow Minister (Work and Pensions)

I am enjoying my right hon. Friend's contribution, as will all patients in Suffolk. He may remember that it was said of the Holy Roman Empire that it was neither holy, nor Roman, nor an empire. Does he agree that the strategic health authority is neither strategic, nor about health, nor an authority on anything?

Photo of John Gummer John Gummer Conservative, Suffolk Coastal

My meetings with those at the strategic health authority, which were wrung out of them—their incapacity to respond to Members of Parliament is legendary—led me to be even more depressed than I had expected due to their inability to answer any of my questions.

Irrespective of the Government's carelessness in not reforming the method of handing out the money, if the strategic health authority had been doing its job it would have stopped the overspending of all PCTs and hospital trusts—that is what it must be there for. The fact that it did not beggars belief. But do the Government fine it? Are they placing on it the responsibility for paying the debts? No—not at all. It is still there, hectoring, except that it now has an even bigger remit—a larger area to fail to administer and to be an authority for.

It is of course unfair to ask PCTs to provide 100p-worth of services for 91.5p-worth of resources—although it is not really 100p-worth because it should be providing what would cost 72 per cent. more, according to the Government's own figures from the Countryside Agency.

Primary care trusts should therefore probably provide 110p or 115p-worth of services and it is hard to ask them to work on the basis of 10, 15 or 20 per cent. below the resources that they should have. Even so, that is their job. It is why they are paid and why they are there. They are accountable to no one except the Government.

The Government appoint PCT members, although there is an arm's length organisation that finds hitherto unfindable people who serve on the boards—most of them unknown to the people whom they represent. None of the non-executive members of our strategic health authority comes from Suffolk or Norfolk, which are two of the largest affected counties. None of them knows about our specific problems. However, they are appointed by the Government. If the appointments commission proposed someone unsuitable, such as me, I doubt whether the Government would confirm the appointment. I have some names that I would like to suggest to the Minister but he will not accept them because the Government want people who kowtow first to the authority and then to them.

The Government, having got the sort and class of people they want—those who do what the Government demand and do not stand up for local people—find that their appointees cannot deliver the goods. Do they fine them? Do those people have their salaries reduced or removed? No. The Government reappoint them and fine my constituents. They say that, because people had more money spent on them in the past than the figures suggest should have been spent, present and future generations must pay.

Waveney PCT was close to paying all its debts and was in credit on a year-on-year basis. However, the Government decided that, far from helping it with the extra money that they promised, it will be fined to help pay for other people whom the Government have failed to control.

The Government are fining my constituents—what is the result of that? It means that NHS provision in my constituency is worse than it was 25 years ago when I was first elected. If the Minister finds that surprising—and it is surprising, given all the extra money—let me explain. In November, the Bartlet hospital, which is a community hospital—the Government have decided to find £300 million to increase the provision of such hospitals—will be closed. The building was presented to the people of Felixstowe through the honourable work of doctors who wanted to provide beds for those who came out of hospital and needed to convalesce. It was especially important for people who live in rural areas and find it difficult to go back to their homes, which are often unsuitable for those who are disabled, at least for a time. Many of them are elderly. People in that part of Suffolk, which I did not originally represent, will no longer have the Bartlet hospital. Some refurbishment will occur in Felixstowe general hospital but there will be a lack of beds for rehabilitation and aftercare, which has existed for all those 25 years.

Let us consider Ipswich hospital. I am glad that Chris Mole is present. We have had little support from him in our battle for Ipswich hospital and that is sad. If Ipswich were represented today by Jamie Cann, Ken Weetch, Dingle Foot or Richard Stokes—four fine former Labour Members of Parliament—they would have been battering on the Minister's door. The Minister would hardly have been able to move without their saying, "Do something about Ipswich hospital." Perhaps the hon. Gentleman has conducted a secret battering, but we have had no support for our fight for Ipswich hospital. I am pleased that he is here because I can give him the figures—I do not think that he knows them. He has certainly not protested about them in our local newspapers. There are going to be 357 redundancies at Ipswich hospital. That figure was confirmed this morning by the hospital's chief executive, and it represents 10.1 per cent. of the work force.

Hon. Members who have listened to the Leader of the House try to explain away the redundancy figures in the national health service will realise just what that means. It is no good the Minister looking through his papers to try to explain how they will not be compulsory redundancies. It is funny how redundancies are no longer called that. All sorts of other phrases, such as "readjustment of staff", are used.

Photo of Richard Spring Richard Spring Vice-Chair, Conservative Party

Redeployment and modernisation.

Photo of John Gummer John Gummer Conservative, Suffolk Coastal

Indeed. So far as my constituents are concerned, however, this is going to be a 10.1 per cent. reduction in the work force, and that will include 31 nurses. There are 100 job losses at Ipswich for every nine in Peterborough. That shows the pressure on Ipswich hospital, which serves my constituency and those of my hon. Friends the Members for West Suffolk (Mr. Spring) and for Bury St. Edmunds (Mr. Ruffley), who have fought a noble battle in the absence of any support from the Member of Parliament who ought to be out there on the streets with us.

There are problems not only in Ipswich but in Aldeburgh, a town of some 2,500 people—a bit more if we include the villages round about. Five hundred of those people are over 65 and living on their own. The Aldeburgh cottage hospital—now the Aldeburgh community hospital—is exactly the kind of community hospital that the Secretary of State is supposed to be in favour of. Aldeburgh has halved the number of beds, even though people in the locality have raised a considerable amount of money in recent years to provide them. Those beds were serving the community; now they are not. Of course, we are told that this is because of a redesign of services.

That redesign of services is based on the premise that there will now be carers in the community, and that the social care system will be able to go out there and look after people. This illustrates what I mean about the decline in the service that is being provided. Any sensible reorganisation would have put the care in the community in place first, and reorganised the hospitals second. If this had not been a matter of saving money, that is how it would have been done. When I talked to people in Ipswich hospital today, as I have done over many months, they made the point that they were happy to move to new frameworks and systems, but that they did not want to move to the new one after the old one has been closed. We should keep the old one until the new one is seen to be working.

The Minister is unfortunate in that he does not spend much time in my beautiful constituency. It has 74 miles of coastline and more than 100 communities, it is very lovely and it is a long way from anywhere. That is a very good thing. In my constituency, however, there are very few carers. The Minister's whole argument is based on the premise that enough carers can be found, but I have to tell him that people who pay for carers with their own money cannot find them. There are not even enough carers to meet the present demand, although there is still the full number of beds in the Bartlet and at Aldeburgh.

My neighbour, my hon. Friend Sir Michael Lord, is not able to participate in this debate because of his position as Deputy Speaker, but he has exactly the same problem in the Hartismere hospital, which I used to represent. That hospital is also under threat, and it will certainly not continue as it is. It will probably be put out to some kind of privatised arrangement, and it might be closed altogether. The fact is that, yet again, we are discussing another community hospital serving an area where carers are almost impossible to come by.

If one in five of the population is already over 65, it is not surprising if it is quite difficult to find carers. That is why the situation is worse today than it was 25 years ago. Of course, it is worse too because then people could go to All Hallows hospital in Ditchingham, just over the border, where Anglican nuns have been caring for people in the most exemplary manner for a very long time. That is to be stopped: the respite and palliative care for the terminally and incurably ill is funded partly through the primary care trust and partly through contributions, but the PCT is withdrawing funding. That threatens the whole service.

The service is worse than it was 25 years ago, and I am sure that the Minister will want to apply that to the whole service, because 25 years ago if people needed a doctor in the night, they could get one. Then, we had a domiciliary calling service. Try that today. On dentistry, 25 years ago, I never had complaints that people could not get on the list of an NHS dentist, but now, of the 14 dental practices in Suffolk, Coastal, only one is taking on new NHS customers. So, I wrote to the Minister's predecessor, who did something that I do not think this Minister would do—he wrote me rather a nasty letter saying that I could have found out about that myself by getting in touch with NHS Direct.

I had written about a constituent in Felixstowe who was unable to get on a list for an NHS dentist. That Minister sent me a list of eight NHS dentists who were, he said, within 10 miles of my constituent's home. Four were within 10 miles and they were indeed NHS dentists, but none was taking on new patients, at least for the moment. I looked with enthusiasm to the other four, only to find that they were all in Frinton.

NHS Direct does not realise that there is a river between Felixstowe and Frinton or that it is some 50 miles to Frinton and 50 miles back. Unless people can swim, they cannot get an NHS dentist in Felixstowe. This Minister has to bear the brunt of the fact that we in my part of the country do not believe that NHS Direct understands.

What makes the difference? Why do we not get the money? Why have our community hospitals not had any of that £300 million? Why are our community hospitals closed? Why are other community hospitals kept open? Could it be that the one thing that distinguishes most constituencies in Suffolk is their political representation?

I was chairman of the Conservative party, and during my chairmanship I would neither have asked, nor been allowed, to play any part in the decisions on the closure of hospitals. I have talked to my colleagues who have been chairman of the Conservative party and they assure me that the same was true of them.

I spent some eight or nine years as a Cabinet Minister. As Secretary of State for the Environment, I would no more have allowed a political person to come in and decide how I would work out the money for local authorities than I would fly. The same was true of deciding whether to close or open MAFF offices when I was Minister of Agriculture, Fisheries and Food. I would have considered that dishonourable and wholly unacceptable.

Indeed, when I was making decisions on supermarkets and out-of-town development, I remember insisting that my officials remove the names of the supermarket companies, because one naturally had those that one liked and those that one did not. I believed it proper always to make those decisions at arm's length.

I am not in any way criticising the Minister, but when we discover that hospital closures are discussed by Ministers in the presence of the chairman of the Labour party, Hazel Blears, we must think seriously about a connection between political representation and the closure or opening of community hospitals. That connection has been made clearer by the list produced by The Times. Surely it is not a matter of accident that all the closures have been in Conservative-held seats, except for a small number in Liberal Democrat-held seats. As I understand it, none of the closures so far has been in a Labour-held seat. I hope that the Minister will tell us how much of the £300 million is earmarked for Hartismere and Aldeburgh, the two community hospitals left in central and eastern Suffolk.

What is the effect of all that on the confidence of my constituents? We have an older population than almost anybody else, and we get less money. We have a more expensive service than almost anybody else—that is on the Government figures—and we get less money. We have a real problem with one-person households over the age of 65, and we get less money. All our PCTs and hospitals have gone into the red and have historic debts to pay off. The Government have taken no responsibility for that at all. All they have done is make our situation worse by fining Waveney, which had got itself into the right position, and, as far as the rest of us are concerned, by forcing people to pay back the money in a single year.

I therefore have five simple questions to put to the Minister. First, of the four community hospitals, Beccles, Lowestoft, Halesworth and Southwold, none of which is currently threatened, two are in the constituency of Suffolk, Coastal held by the Conservatives, and two are in the marginal constituency of Waveney, which will not be held by the Conservatives until after the next election. Does he therefore accept that we will watch carefully to see that all four remain open and that a choice is not made on the basis of political representation or the nature of marginal seats?

Secondly, will the Minister agree to go back, look at the debts and recognise that the local PCTs are underfunded? To enable them to return from their current terrible base to some kind of service that equates with what was there 25 years ago, and certainly that equates with what the Labour Government would no doubt say they are proud to have achieved in other parts of the country, does he agree that those debts will either be cancelled, as has happened in a number of cases, or paid without penalties over the next five years?

Thirdly, the Minister of State, Department of Health, Ms Winterton told the strategic health authority that the old services would not be closed before the new services were in place. In front of me and the hon. Member for Ipswich, who was present on that occasion, she said clearly that that was what should happen, and the SHA said that it could not happen, because it did not have the money. Does the Minister therefore accept that the services will not be closed until working replacements are in place throughout the county of Suffolk?

Fourthly, will the Minister consider the appalling position of midwives? It will now be almost impossible for women to have babies at home in many rural parts of Suffolk because of cuts, reduction in grading and the fact that that is another area in which savings can be made.

Finally, will the Minister promise me that he will talk to Suffolk county council about the pressures that are now being exerted on its social services department? The department is already hugely overspent, and has already been cut because of the Government's pusillanimous post-election arrangements for the county council. Will he promise to sit down with members of the county council and establish what extra help it can be given to deal with the situation with which it has been left after the closure of so much of Suffolk's heath provision?

I have said all that without going into the detail of the appalling cuts affecting those who are least able to defend themselves—the mentally handicapped in my constituency and elsewhere. I must tell the Minister that I cannot think of a circumstance in all my years as a Member of Parliament in which I have seen a national service that is much prized, much loved and much depended on destroyed by an accounting system that is manifestly bent away from the needy in Suffolk.

Photo of Richard Spring Richard Spring Vice-Chair, Conservative Party 5:51 pm, 19th October 2006

I congratulate my right hon. Friend Mr. Gummer. I hope that the Minister heard the genuine passion in his speech. It is shared by the other Conservative Members in the county, all of whom face the same huge problem.

Let me take this opportunity to pay tribute to the staff of the NHS in Suffolk. My right hon. Friend talked of the staff cuts at Ipswich hospital. My hon. Friend Mr. Ruffley knows from his constituency what is happening at West Suffolk hospital. I can tell the Minister that the collapse in morale among wonderful, caring professional people—our nurses, doctors, ancillary workers and community nurses: all those who make the NHS work—is devastating. They come up to us in the street, sign petitions and take part in marches. They simply cannot understand that in this country, the fourth richest in the world, we are seeing the decimation of something that is of great value and cherished by the people of this country: our national health service.

I think the Minister will agree that the clergy are not always ready to come forward on issues that may be controversial. I have lived in the county of Suffolk for a long time, and I am sure that my right hon. Friend finds the same. The clergy in the western part of Suffolk were so horrified by what was happening to the health service that, as a result of pressure from parishioners who approached them expressing concern about the decimation of services, a petition was organised throughout western Suffolk and signed by more than 1,000 people. I believe that that is unprecedented in the history of our county.

I became a Suffolk Member of Parliament in 1992. At the time there was a discussion about reorganisation, and I witnessed the disappearance of West Suffolk health authority. I was told that it was necessary for reasons of economies of scale, procurement and all the other things that would benefit a larger, pan-Suffolk health authority. Not many years ago, against the professional advice of people in the NHS and the county and, indeed Members of Parliament, five primary care trusts were created—all with their chief executives, staff and headquarters, and with all the attendant costs—allegedly to bring health services closer to the people whom they served. Well, of course, we then landed up with three PCTs. Now guess what: we are back to square one and to having only one PCT. Why? It is because creating services allegedly close to the people somehow has not worked. We are now back to large-scale procurement, economies of scale, cheaper purchasing and all the rest of it.

Photo of Richard Spring Richard Spring Vice-Chair, Conservative Party

I will come on to the question, you bet, of new offices.

My right hon. Friend the Member for Suffolk, Coastal talked about the funding formula. I happen to have been a member of the Health Committee before 1997, and I think I have understood something about the funding formula for the NHS. When there was a change of Government and the funding formula was modified, my hon. Friends the Members for Bury St. Edmunds (Mr. Ruffley) and for South Suffolk (Mr. Yeo) went to see the then Secretary of State for Health to point out the very issue that my right hon. Friend has talked about—the impact that the funding formula would have in areas where the age profile of the population was older than in many parts of the country. He gave the assurance that it would be monitored and since then, as the Minister will confirm, there have been many changes which have further enhanced the gap between the so-called deprivation index and the age profile. This is at the heart of the problem.

In 2007-08 in my constituency the per capita spend on the NHS will be £1,156. In the Prime Minister's constituency it will be £1,576. That is a £420 difference, up from £391 in the current year. The figure in my constituency is comparable to that of my right hon. Friend the Member for Suffolk, Coastal and my hon. Friend the Member for Bury St. Edmunds and is well below the national average, for the reasons that my right hon. Friend described. Of course, that is at the heart of the problem. The funding formula is skewed in a way that has made the adequate funding of the NHS in Suffolk well nigh impossible.

We have heard something about the strategic health authority. I invited members of the SHA in the first instance to come to London to talk about what very obviously two years ago was going to be a crisis in our county. They came, and I well remember the meeting because there was definitely an atmosphere of "You Members of Parliament are being hysterical. We are carefully watching the situation." They showed the most extraordinary complacency. However, something must have dropped—the penny or whatever—because only a few weeks later the chairman and chief executive resigned. Perhaps they had begun what they should have done, which was to look at the figures for what was going on in the county, and they did not want to be around when something started hitting the fan.

We had another meeting subsequent to that, with the new chief executive. I remember the atmosphere there as well. It was extremely aggressive. "We are sorting this out", they told us. They had recovery plans. The idea that there would be massive deficits was a huge exaggeration, because the authority had the matter under control. That simply was untrue. At the most recent meeting there was an admission of total despair and an acceptance that everything that we had forecast to the SHA had materialised. If a strategic health authority could not look at the figures from all the PCTs in the then three counties under its control and see what was so screamingly obvious to the Members of Parliament and which it should have picked up—that a crisis was developing—I have no understanding of what SHAs exist for. They simply have not been doing their job. That is exactly why they should have no right to exist. They are now conducting an exercise to look at the future of our acute care services in the region. I simply dread to think what they will do, given the performance that we have suffered from these people in the past.

Let me deal with the extent of the deficits. The county of Suffolk has some 650,000 residents. It seems to me as we look at the figures that the current deficit in the county is about £64.5 million—the cost of the creation of the new PCT. That includes the health trusts and the hospitals. We know, for example, that Suffolk West PCT has passed on a deficit of £16.1 million to the new PCT; and we know that in the east of Suffolk, the PCTs have passed on a total deficit of—

It being Six o'clock, the motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, That this House do now adjourn .—[Mr. Heppell.]

Photo of Richard Spring Richard Spring Vice-Chair, Conservative Party

The deficit in east Suffolk is £35.4 million, with the deficit in the West Suffolk hospital trust at £14.4 million, leaving a total of about £50 million. We understand—and my right hon. Friend the Member for Suffolk, Coastal will know that the information has been checked and published—that the shortfall in the Ipswich hospital may reach something approaching £50 million in the course of next year. We are therefore talking about a huge emerging deficit on top of the existing one and the possibility of some so-called user charge of 10 per cent. That would mean a staggering deficit in the region of £100 million.

I shall put a further point to the Minister. We hear about savings, but it is rather like putting something that costs £1 up to £1.50, then reducing it to £1.40 with an announcement of a 10p saving. That is exactly the logic of the situation. There have indeed been attempts to make savings, but the pattern of deficits—both current and, in particular, historic—has continued to rise.

We have had some discussion of rehabilitation beds and I must say that I took some comfort from the Secretary of State's remarks that community hospitals should not close on short-term financial grounds. Newmarket hospital in my constituency, for example—a 10-year-old hospital that is much valued and cherished by the local community—is in danger of losing its rehabilitation beds. The bed spaces have to be used because of the repeated crises happening at the West Suffolk PCT and at Addenbrooke's—almost constantly on black and red alerts. In those circumstances, they have to move people into the bed space simply to accommodate individuals.

In respect of the Newmarket hospital, 1,000 people marched in protest at the removal of these beds and a massive petition was organised. The problem is well known to everyone who works in the hospital, where morale is, of course, extremely low. As my right hon. Friend rightly said, if the beds go, it is a fantasy to suggest that there are appropriate support structures in the local community. There are already not enough carers and the idea that somehow this is all about modernising care or bringing it into the 21st century with all its support structures is simply untrue. We have heard the warnings from Lord Bruce-Lockhart about the pressures on social care budgets all over the country in the forthcoming year. Why has all this happened? It is partly to do with the funding formula, but it is difficult to get proper and adequate information about the real extent of the deficit. The proof of the pudding lies in the cuts in services and the sackings of staff.

We now have a new Suffolk PCT and the first thing that it did was to create a new headquarters—an interesting decision. If a family is in great difficulties, it does not move house, but makes do. I make that point very simply and we look forward to a meeting with the new chief executive of the new PCT, at which a whole series of important questions will be asked.

In conclusion, the Minister should recognise that it is a truly extraordinary situation when people who believed that the health service would protect them find that it is being demolished in front of their eyes. Of course there have been some improvements in aspects of primary care and I accept that there have been improvements in other spheres, but our acute care services are under threat and it now looks as if our community beds are very much under threat. The deficit and the debts come together to create an impossible situation. Ultimately, the problem comes down to fairness. It is about fairness to people living in Suffolk who are watching what is happening to their health service and who look at other places where the funding formula does not have such a negative effect. They feel that they are being treated extremely unfairly.

Several hon. Members:

rose—

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. Before I call the next speaker, I ask Members to recognise that the Minister may need a little extra time to reply to Mr. Gummer, who initiated the debate.

Photo of Chris Mole Chris Mole Labour, Ipswich 6:05 pm, 19th October 2006

Thank you, Mr. Deputy Speaker. As you may gather, it was not my intention to intervene in the debate, but given the length of time available I want to address some of the issues that have been raised.

I am particularly concerned about the co-ordinated attack that has been made, because I was the victim of such an attack from Conservative Members when I was the leader of Suffolk county council. They cloned a debate from Kent, in which the county council had been attacked by Kent Tory MPs, so it is a pity that such an attack has been made again today.

The comments of Mr. Gummer were unfortunate, especially because, as a constituency MP, I have regularly engaged with my health trusts—the Ipswich primary care trust, which was the predecessor to the Suffolk East PCTs, the Ipswich Hospital NHS Trust and the Suffolk Mental Health Partnership NHS Trust—and my understanding is that until some of the events described, the right hon. Gentleman had not set foot in Ipswich hospital for some years. The partisan comments we have heard this evening are regrettable; they have avoided a balanced look at developments in our local health economy.

We have heard nothing about what has happened in terms of key issues for many of our constituents, such as waiting times for elective surgery at Ipswich hospital. In April and May last year, more than 500 patients had been waiting more than six months. Unfortunately, the hospital has not yet met its target; at present, one person has been waiting for more than six months for elective surgery. At the same time last year, more than 500 out-patients had been waiting more than 13 weeks from their visit to their GP to their first appointment. However, I am pleased to say that the number is now zero; none of our constituents are on that waiting list.

We need to be honest about the situation. Clearly, there are financial challenges that all trusts have to address, but we must not wrap all the service changes into them. It is unfortunate that we have heard some rather head-in-the-sand observations, more focused on buildings and beds than outcomes for patients—the sort of things that our constituents expect us to deliver across the public service remit: not bricks and mortar, but services.

There are changes in the nature of surgery, such as day surgery. In the past, a day's preparation and several days' recuperation in an acute hospital were needed; nowadays, the procedure can be completed in 24 hours and the patient is back where they want to be—at home—as soon as possible. That reduces demand for the number of beds in an acute hospital such as Ipswich hospital and for the number of operating theatres, some of which, according to the hospital management, have been running at as little as 50 per cent. capacity recently.

We need to be responsible, to face up to the realities of some of those changes and to ensure that, when people move on from hospital, they get the support that they want. It is not necessarily just about social care, which was the focus of some of the comments from Opposition Members. The important thing is the intermediate health care that follows somebody's time in an acute hospital. Given that focus, I suppose that it was not surprising that there was no mention of the £2 million developments in intermediate health care and the opening of the new Bluebird Lodge in my constituency, which is designed to provide modern, 21st century facilities for all sorts of patients, including older people. There is a particular focus on physiotherapy and active engagement. By that I mean not just letting people sit in what might be termed a recuperation hospital, but possibly in an old Victorian establishment that does not meet people's needs in the 21st century and where people do not get active intervention to allow them to lead independent lives.

I will mention the social care situation, because it is clearly important and, to a degree, it is a linked issue. During the 12 years that Labour was in leadership in Suffolk county council, the number of home care packages were expanded enormously. The number had been cut under the Conservatives up until 1992. It is, of course, disappointing that the instant that Suffolk county council returned to Conservative control, those resources went backwards again, as other choices were made about spending on rural minor roads or whatever.

I am not prepared to stand here and hear our health services done down by the Conservative party. If any of the Opposition Members had made the effort, as I did, to ask about the relative per capita funding of our trusts in Suffolk, going right back to 1987, under the old Anglia and Oxford region, which I am sure the right hon. Member for Suffolk, Coastal will recognise from his days in government, they would know that that trust was funded below the national average at exactly the same level as the situation today. As I am sure that the Minister will explain, the formula recognises the needs of older people, as it does the needs of those who have disadvantages in their health.

Let us look at what has been happening at Ipswich hospital. I mentioned some of the service performance improvements, but there are some tough decisions being made. It is particularly regrettable that there have to be some reductions proposed in the specialist nurse services, which, apparently, the hospital is not commissioned to provide. At the same time, other changes are being made to the clerical and administration posts and to consultant secretaries. All those things are making significant contributions to the savings that the hospital needs to make to get into balance, as it has always been required to do statutorily.

Despite all that, we want to see a health service that is fit for the 21st century. I welcome the fact that, among the developments, is our brand new linear accelerator at Ipswich hospital, which is improving the delivery of cancer services—they are among the best in the UK. My constituents have only to drive by to see the construction of the brand new Garrett Anderson building, which will provide new accident and emergency services.

Photo of David Ruffley David Ruffley Shadow Minister (Work and Pensions)

Will the hon. Gentleman join me and all those who are served by district general hospitals in Suffolk and Norfolk to fight any cuts to accident and emergency services, which, if the rumour mill is to be believed, could well be the result of the strategic health authority review that is due by the end of the year? Will he join me in the fight to save A and E services in our district general hospitals, especially in Ipswich and West Suffolk hospitals?

Photo of Chris Mole Chris Mole Labour, Ipswich

I make a habit of not listening to the rumour mill. I have found it interesting to see on the local media that there are campaigns going on all over our region that are based on rumours. I would not like to hypothesise about the origins of those rumours, but it seems that they are being used for particular political ends. Building on the investment in the accident and emergency department at Ipswich hospital, in which no one of course waits more than four hours for their treatment, I am confident that we will see in the Garrett Anderson an even better and further improved accident and emergency facility, and I have no doubt that it will be there for many years.

Photo of Andy Burnham Andy Burnham Minister of State (Department of Health) (Delivery and Quality) 6:16 pm, 19th October 2006

I congratulate Mr. Gummer on securing the debate. I know that he pays a great deal of attention to the issues that he raised, and I do not doubt the sincerity with which he brought them to the House. I know that many people in Suffolk will be watching this debate and looking at its outcome, so I also thank the hon. Members for West Suffolk (Mr. Spring) and for Bury St. Edmunds (Mr. Ruffley) and my hon. Friend Chris Mole for attending.

Like the right hon. Member for Suffolk, Coastal, I want to congratulate NHS staff in Suffolk on the hard work that they have put into improving services and performance. Thousands of people are receiving high-quality care and safe services each day. The best of the NHS in Suffolk is among the best health care in the world, so we should all be proud of its achievements.

We are midway through a 10-year NHS plan. The achievements that the NHS is making nationally are outstanding. Waiting times for in-patient treatment have fallen to 26 weeks, compared with 18 months or more in 1997. The maximum waiting time for an out-patient appointment with a consultant has been halved to only 13 weeks, and 98.8 per cent. of patients are now seen, diagnosed and treated within four hours of arriving at an A and E department, as my hon. Friend the Member for Ipswich said.

I set out that context because although I was grateful for the kind words of the right hon. Member for Suffolk, Coastal as he opened the debate, I felt that there was a significant lack of balance in his contribution and that of the hon. Member for West Suffolk. Wild claims were made about the state of the national health service in the region. I do not believe that the claim that the NHS is worse than it was 25 years ago can be backed up by evidence. I will substantiate that remark, but I urge the right hon. Gentleman, who is an experienced parliamentarian for whom I have a great deal of respect, to consider whether several of his claims reflect the reality on the ground in his constituency. All the achievements to which I referred are being carried out in his constituency.

In some ways I will now go off my script. I took it that the crux of the contributions made by the right hon. Member for Suffolk, Coastal and the hon. Member for West Suffolk was the funding formula, so let us deal with that head on. During his speech, the right hon. Gentleman said—I think that I quote him correctly, but if I do not, I am sure he will put me straight—that old age should be the major indication of need in the national health service and that his area should thus get more than average.

May I refer the right hon. Gentleman to a document that his own party produced in the past month, which called for NHS funding

"to accurately reflect the burden of disease"?

That is a direct contradiction of the argument that he put to the House. The burden of disease does not equate to old age. Indeed, longevity may be a sign of good, not bad, health.

Let us consider some of the differences in the burden of disease. I take my constituency as an example, to make the comparison real. In my constituency, the cancer mortality rate per 100,000 for people under the age of 75 is 134. In Suffolk, Coastal the corresponding figure is 102. The coronary heart disease mortality rate per 100,000 population for people aged under 75 is 83.80 in my constituency and 35.52 in Suffolk, Coastal. The incidence of stroke among the under-65s is 11.72 in my constituency and 5.04 in Suffolk, Coastal. The Conservative party is telling the Department of Health that health funding should follow "the burden of disease". From those figures, the right hon. Gentleman will see clearly where that burden lies.

What is the claim made by all the Conservative Members who have spoken in the debate? Is the claim that health funding should not follow the burden of disease—should not go to where the need is greatest—or that it should? I am genuinely confused about the position of the Conservatives on the issue, which they said was the crux of the debate.

Photo of Richard Spring Richard Spring Vice-Chair, Conservative Party

Of course there are areas of the country that have always been recognised as areas of special deprivation. For example, there are problems of bronchial diseases in some parts of London. That has always been recognised in the funding of the health service.

Photo of Richard Spring Richard Spring Vice-Chair, Conservative Party

Of course it has. It would be absurd not to recognise that. At base, there is a question of balance. If a funding formula creates a situation where hospitals are in crisis and are sacking people, that is not fair or balanced.

Photo of Andy Burnham Andy Burnham Minister of State (Department of Health) (Delivery and Quality)

The Black report was not recognised by the hon. Gentleman's Government. That ground-breaking report on health inequalities was not recognised. That is why there are health inequalities that still shame this country and why there is an unacceptably large gap in life expectancy between parts of the north and parts of London. The lowest male life expectancy in the country is in Manchester. There is a gap of some eight, nine or 10 years between parts of London. Health inequalities have not been adequately recognised. That was the point of the Conservatives' document, but this evening I hear a different argument played out to me.

Let us be clear. The claim was for more money for the PCT, but the document says something different. If we followed the logic of the document on the basis of the figures that I gave, there would be more money going to other parts of the country, rather than less. I do not go along with that argument. We need a balance across the system, but we must recognise where ill health is greatest.

At the last general election each and every one of the Opposition Members present stood on the patient's passport proposal. Each and every one of them voted against the national insurance increases to help fund the national health service. Is there not a twinge of shame that in their contributions there was not a jot of recognition of the stance that they took and what that would have done to health services in Suffolk, had we listened to the Conservative party? Is there not a minute when the words ring a little bit hollow and they feel a little ashamed of some of the claims that have been made? I would, if I were in their place.

The right hon. Member for Suffolk, Coastal claimed—to borrow his words—that they are not getting any money, or anything else, and that the decisions are all political. There was no mention of the £1.4 million that is being invested in Felixstowe to turn the old general hospital into a modern community hospital, which will include a day treatment centre, 16 in-patient beds, musculoskeletal services and a range of other clinics and services. Work is due to commence on that project next month—on 7 November, I believe—but there was no mention of that in the right hon. Gentleman's contribution.

The hon. Member for Bury St. Edmunds did not speak for long, but I did not hear any mention of the £600,000 in capital and revenue that is being invested in Mount Farm surgery in Bury St. Edmunds, enabling 3,000 more patients to register with the surgery and to have access to an extended range of services. That backs up my point that there was no balance in the remarks that were made. Real improvements are being made on the ground in the hon. Gentleman's constituency. It is misleading to claim that everything is being done according to a predetermined political agenda and that no investment is being made.

I turn to some of the more general points that were made about funding as a whole. The NHS is in receipt of record resources because of the Government's funding policy. Funding has increased from a little over £34 billion in 1997-98 to more than £69 billion in 2004-05. It will increase further still, to £92 billion, in the next financial year.

NHS organisations have always been expected to plan for, and achieve, financial balance each and every year. If the Opposition are claiming that there should be no financial rigour in the system—that organisations should be able to spend more than they receive—that is an interesting position to adopt, but it is not one that we will follow. It must be said that the current financial situation in Suffolk cannot be attributed to a lack of funding. The four primary care trusts in Suffolk collectively received allocations of £659 million for this financial year. The NHS is required to generate a break-even position in 2006-07. All NHS organisations—including, of course, those in Suffolk—are expected to achieve run-rate balance by the end of this year.

It does not help local people's understanding of the difficulties and pressures that all health systems in developed countries are under when wild claims are made about a particular situation. I think that I heard the hon. Member for West Suffolk, who made a long speech, say that he expected there to be a £100 million deficit next year.

Photo of Andy Burnham Andy Burnham Minister of State (Department of Health) (Delivery and Quality)

That is a wild claim that does nothing to aid local people's understanding of the pressures on the system, or to enable them to know whether the quality of health services can be sustained. I make a plea for some facts in this debate, so that we can let people make their own judgments. Talking about a rumour mill does not help when the rumours are perhaps being started in this very Chamber. Let us have some balance and facts in this debate and some leadership from politicians in their communities. Let them explain the changes happening to health services locally and ensure that people understand the issues that we face.

Photo of Andy Burnham Andy Burnham Minister of State (Department of Health) (Delivery and Quality)

I have just a moment left.

The right hon. Member for Suffolk, Coastal asked me five questions and I will write to him in detail on all of them. On the question of Suffolk county council, which he mentioned, my hon. Friend the Member for Ipswich was absolutely right. While social care does need the funds to provide an adequate level of service throughout the country, the right hon. Gentleman should perhaps talk to his colleagues on the county council to ensure that they give sufficient priority to social care and deliver the services that we all want to see.

This has been a long debate and we have covered a lot of ground. I am grateful for the opportunity to put some facts on the record, because I believe that they were severely lacking in the contributions that we heard this evening.

Question put and agreed to.

Adjourned accordingly at half-past Six o'clock.