Health Services (Oxfordshire)

Part of the debate – in Westminster Hall at 12:59 pm on 2nd July 2002.

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Photo of Boris Johnson Boris Johnson Conservative, Henley 12:59 pm, 2nd July 2002

I am pleased that time has been found for this debate, although I am sorry that no other Oxfordshire Members of Parliament have seen fit to attend the proceedings. Perhaps they will join us in due course.

Adjournment debates tend to begin with a whinge about health care, develop into a wail and wind up with a general howl of protest. Let me vary the routine and start with an unrivalled success story which I hope the Minister will appreciate. In about a month's time, the first brick will be laid of the new Watlington hospital in my constituency. It will be marvellous—the type of place in which all hon. Members might hope to wind up, spending our last days gently pottering around in its gardens, looking at the lovely flowers of south Oxfordshire.

There will be 60 beds—some national health service, some private. A quarter will be for the use of mental patients, a quarter for convalescence, a quarter for long-stay elderly patients and a quarter for respite care—to give a break to disabled children's parents who are at the end of their tether. There will also be a brand new NHS GP surgery.

The whole project has NHS approval. I am sure that the Minister will be especially pleased to know that the project has so far been accomplished without spending a penny of public money. Two and a half years ago, the Government closed the small cottage hospital in Watlington—a move bitterly resented by the local population. They have responded magnificently, thanks to the tireless work of Sir Charles Farrell and many others. Donations have been collected, both large and small, and the people of Oxfordshire have raised £1.5 million to reverse an ill-judged closure by the Government. I am sure that the Minister will want to join me in congratulating all those responsible for that achievement. At the risk of tempting him into a departure from Labour's approved ideology, I invite him to agree that it shows what private enterprise can do in the field of health care.

The real question is why the people of Oxfordshire felt so ill-served by their hospitals that they wanted to rebuild one at their own expense. I firmly believe that Westminster Hall debates are not a time for scoring party political points. I do not want to attack or undermine the many health care professionals in my constituency who do a fantastic job in difficult circumstances. However, one reason why it was necessary to build again at Watlington was the shortage of care home beds. We all know that care homes are closing throughout the country at a prodigious rate, thanks in large part to the detailed provisions of the Care Standards Act 2000. In Oxfordshire, half the care homes are predicted to close by 2007.

The closure of care homes is producing the phenomenon of bed blocking in our hospitals, when elderly patients cannot leave and impede the arrival of other patients. At the John Radcliffe hospital, the biggest and most important in Oxfordshire, 46 beds are currently blocked. A further 36 or so are blocked in Oxfordshire's various local hospitals.

There are currently 80 beds in the John Radcliffe that are closed altogether, making it difficult to get in. One GP in my constituency told me yesterday that she had a patient with jaundice whom she could not get into the John Radcliffe. Although he was not, as far as she could tell, in imminent danger, he was in pain and distress and she wanted him to be seen. She could have put him on the cancer list because, according to Government rules, people with cancer must be seen within two weeks—if not actually treated, because one might have to wait a lot longer for that. However, she was not sure that he had cancer, so he had to wait and wait.

Another Oxfordshire GP, Dr. Tony Vernon of Wallingford, recently revealed that he had been unable to get patients into the John Radcliffe because the ambulances meant to be taking them there were not available—they were queuing up outside the hospital supplying trolleys because there was a shortage at the accident and emergency department. From January to March, 84 patients had to wait more than 12 hours in A&E at the John Radcliffe. Sometimes that service is closed, and people cannot get into A&E at the hospital—the biggest hospital serving Oxfordshire—because it is on what is called a divert. People are diverted to as far away as Stoke Mandeville.

When people like me make such criticisms of dedicated health care professionals, it is important that we take account of the problems that they face. A single explanation for the problems of the John Radcliffe may tell us why beds are not only blocked, but closed. We talk about a shortage of beds; the bed is physically there, but it is unavailable for use. The explanation is a shortage of nurses.

There is a 13.6 per cent. shortfall in the nursing strength at the John Radcliffe hospital. That is about 300 nurses short in a crucial hospital that serves many people in my constituency. Of the 1,250 nursing posts in Oxfordshire, 377 are unfilled. That is why beds are not only blocked, but closed. That is why general practitioners find maddening delays in putting patients into secondary care, and broadly why one in 20 planned operations is cancelled on the day of the operation. It is why the A&E seems to be in such a crisis.

The problem of recruitment is at its worst in the south-east, and retention of nurses is also difficult. One in eight registered nurses left the national health service in the year to March 2001 in the south-east region, the area most badly afflicted by wastage. Why is it so difficult to recruit and retain nurses in the south-east? Why is it necessary to try to recruit nurses from the Philippines and other countries, as the Radcliffe has been forced to do? As the Minister will have seen, that has prompted protests from some third-world countries, which have said that they are being denuded of health care workers.

The pat answer is the cost of housing. It is certainly difficult to live on a nurse's wage in Oxfordshire. Does the Minister agree that there is not only too little pay, but too little flexibility in pay? The south-east region has a discretionary weighting of between £400 and £600. That hardly competes with the London weighting of £3,000 for a nurse.

Oxfordshire certainly needs more money. In 2001, the Department of Health instructed Oxfordshire to make cuts in its hospital budget of £7 million. The cuts that we are all aware of in Oxfordshire social services have a knock-on effect on our hospitals, as I have tried to explain. Is it not also true that the NHS trust could be given more freedom to recruit and reward nurses without having to use the "one size fits all" national pay scales?

Does the Minister agree that, in a diverse economy, with house prices fluctuating wildly between Oxfordshire and Renfrewshire, it does not make sense to give nurses the same basic pay across the board? Does he agree that it is time to start to move away from national pay scales? I hope so. It is unfair to impose consumerist disciplines on the NHS without giving it the freedom to respond. For instance, Tesco has answered the housing crisis in the south of England and Oxfordshire by building housing for its workers. Should the NHS also have such freedom?

Funding is a problem in Oxfordshire, but it is not the only problem. The John Radcliffe has been told by the Government that it is officially a failing hospital on their Egon Ronay or Michelin-style survey of performance indicators. It scored nul points—it got nought. That was demoralising for the people working in the hospital. Whatever the failings of the John Radcliffe, it does not make sense to stigmatise a hospital in that way and to blame its managers, unless they have the freedom to solve the problem. They should have more freedom to recruit nurses, and more flexibility in pay.

I conclude with an angry correspondence between a GP and a consultant. The consultant is a constituent of mine, the GP is not, and I shall keep their identities private. The GP has written a furious letter about a patient who suffers from osteoarthritis. I shall quote long extracts from the exchange, because they give a flavour of what is going on in the NHS in my constituency. The GP wrote:

"I would be grateful if you would urgently look into the case of this now 60 year old man, and explain to me why progress in his care has been so slow. I referred him to you on 10 April 2001. He had significant osteoarthritis affecting both hips, 'unusual for a man of this age'. He was offered his first appointment with you in March 2002. That is 11 months after the original referral and well outside I believe any reasonable guidelines. As I was so concerned by this I wrote to you on 15 June last year and he was seen by your physiotherapist in December. She confirmed my findings, noted his 'considerable disability', and agreed with me that he 'warrants surgical intervention'. He has heard nothing more. In summary therefore I have a relatively young man with major bilateral hip disease, barely able now to walk, and seen in the 13 months since I referred him by a person who, whilst extremely skilled in her field, was only able to confirm my initial view, that he requires surgery. Such patient management makes a mockery of NHS waiting list guidelines and I would be grateful if you and your Chief Executive could explain to me what has happened. For the sake of my patient, I would be grateful if he could be called in immediately for your assessment and that he waits no longer for his surgery than as if he had been seen in Outpatients after no more than the usual delay."

That is a stinging letter for a GP to write to a consultant, and the consultant was very wounded. He wrote a long reply, defending the delay and trying to explain what went wrong. It would be to our advantage to hear his concluding paragraph:

"I cannot tell you how depressing it is replying to letters such as yours. You state, 'Such patient management makes a mockery of NHS waiting list guidelines and I would be grateful if you and your chief executive could explain to me what has happened'. Surely you must realise that 'NHS waiting list guidelines' make a mockery of patient management. Ridiculous and unachievable 'targets' set for political gain place an unsustainable strain on everybody involved in patient care in this Trust. In that I include not only all those who interface directly with patients but also our excellent management team who have to produce figures showing that we have met the 'Targets', or face dismissal. You must appreciate that meeting 'Targets' diminishes clinical flexibility. The harder we are driven to meet 'Targets' the less able I am to treat someone such as your patient quickly because we cannot risk not treating someone else within a specified time."

There we have two angry health care professionals—a GP blaming the consultant for the delay in seeing his patient and the consultant blaming the system of targets and quotas that gets in his way and prevents him from dealing with patients according to need.

If we are to improve health care services in Oxfordshire, we cannot rely on the charity and beneficence shown by the people of Watlington in rebuilding their own hospital at their own expense. We also need a fairer spending assessment for south Oxfordshire and we should stop castigating health care professionals, such as those in the John Radcliffe, without giving them more freedom to run their own lives, to recruit nurses as they see fit and to treat patients according to need, not according to some Whitehall-imposed system of targets and quotas. I thank the Minister for listening to me so patiently and in such splendid isolation this afternoon. In the absence of any other Oxfordshire Members to make the case for health care in my constituency, I look forward to hearing his response.