Acute Hospital Services

Part of Opposition Day — [6th Allotted Day] – in the House of Commons at 5:01 pm on 21st February 2007.

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Photo of Alistair Burt Alistair Burt Shadow Secretary of State for Communities and Local Government 5:01 pm, 21st February 2007

Yes, it is true. I cannot spend any more time now on that point, but the Minister will have a chance to deal with it in his winding-up speech.

What I have said is true, and that creates a concern: if the same pattern of funding underpins the acute services review in our region, how can we be sure that decisions about where hospitals will be placed will not be made on the basis of the economics of the area rather than on the clinical needs of my constituents?

We also want to be sure that after the review is concluded hospitals and trusts will be able to get on with doing their job without the Government breathing down their necks and constantly making decisions about their funding and how they should spend money. The Minister knows about the current situation at Bedford hospital. There is a deficit of £11.9 million. That forces the trust to do some remarkable things that waste still more money.

Last summer, the trust decided that it could not replace an orthopaedic surgeon, but the flow of orthopaedic work did not diminish as expected. At Christmas time, staff were made redundant and wards were closed—that happened under Labour, I remind the Minister. Now, in the new year, it suddenly appears that there is so much orthopaedic work to be done that patients' waiting times will hit the cliff edge of the new 18-week target that has been agreed, so more money has been found in order to make sure that that does not happen.

In fact, the treatments proposed will be more expensive than would have been the case if the trust had been able to replace the consultant and follow a normal pattern of work from summer until the end of the year. More money will go into the private sector, and money will be spent on evening operations if the staff can be found to do them, because Bedford Hospital NHS Trust is now readvertising for staff whom they sacked just a few weeks ago in the round of cuts at Christmas time. If the Minister can sit before us and think that he is presiding over an efficient and effective national health service as far as economics and financing are concerned, I am extremely surprised at him. He has a mess in those regards, which he must deal with. How can we have any confidence in the review if that is the economic basis underpinning it, under which hospitals will run?

If the movement of services into the community is to work, the GPs in an area must be able to take on the extra capacity and do the job required of them. I presume that the Minister agrees that that is the case. However, I recently spoke with Dr. Peter Graves, the chief executive of Bedfordshire and Hertfordshire Local Medical Committee Ltd, and he has passed on to me a series of concerns about GPs and the primary care service not being ready to meet the extra demands placed on them by the Government.

First, GPs need to be trained to become GPs with special interests. Unfortunately, the resources for that are not available, so GPs cannot get the training that they need in order to take on those specialties. Secondly, there is an issue to do with training multi-skilled professionals—the further training of other clinical professionals to cover the GP while he or she is carrying out semi-specialist services. Dr. Graves says:

"It remains very difficult to find appropriate training for nurses and other staff, and indeed difficult to find the nurses willing to undertake such training in the first place. In order to deliver Secondary Care services in Primary Care a multi-skilled workforce is essential."

Thirdly, he talks about premises:

"The third aspect of this issue is around practice premises. Whilst there are some large purpose built premises in Central Bedford, which might have the equipment and space to undertake further services (should the staff capacity be available) many practices around the outskirts of Bedford and in North Bedfordshire remain totally inappropriate. We are reliably told that there is money available for the development of premises and yet we are having enormous difficulty accessing this and finding the necessary support to develop premises."

My constituents' perception of the acute services review is, first, that it is underpinned by dodgy economics, as reflected in rural and semi-rural areas, and secondly, that there is an issue to do with the way in which the finance is handled, as hospital administrators are forced to work with one hand tied behind their back, never knowing what their financial regime will be almost month to month. During the course of this financial year, some of them had to make £4 million-worth of savings and they were handed an extra £500,000-worth of savings in October because of a decision that involved deficits throughout the rest of the region.

There is also the question of whether such decisions will be made from the top down, or whether clinicians and doctors will be involved. As my hon. Friend Mike Penning said, a lot of clinicians feel that they are out of the loop. Doctors and clinicians are not going to take these decisions; they will be taken from above, by administrators and people directed from Whitehall.

There is another problem. Once services have been reconfigured—once the decision has been taken to take them from the hospital and place them in primary care— who is going to do this work if the GPs have not been trained to do it and they do not have the necessary premises and staff capacity? We are heading toward a repeat of what we have seen in the past 10 years: well-intentioned efforts by the Government and huge sums of money being spent, but a real mess on the ground. As a result, their efforts simply are not effective.

Unless the Government stop living in a fantasy land in which there is no criticism and the Secretary of State believes that everything is working as she wants it to work, there will be no real delivery for patients, doctors and our constituents. All that we Conservatives are trying to do is to point out those problems, and that the health service and the people who work in it deserve rather better leadership all round than their hard work, efforts and determination are receiving.