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Mr. Tyler: Will any of the links to the west coast main line take the TEN into the wilds of western Scotland?
Mr. Watts: From memory, I cannot recollect whether the links go into the wilds of western Scotland, but I will write to the hon. Gentleman. I prefer not to rely on my failing memory.
Services on the east coast main line already reach speeds in excess of those stipulated for the greater part of the route, so it is represented as "upgraded high speed". The channel tunnel rail link will be capable of speeds of up to 186 mph, and is therefore shown as a planned high-speed TEN route. Proposals for upgrading the west coast main line are being advanced, and the line is therefore shown as a planned upgraded high-speed line, although final decisions have yet to be taken on the future speed capability of the route.
Since the start of discussions on TENs, British Rail and Railtrack have advised the Department that the UK rail TEN should show the line from London to Bristol and
Cardiff as planned high speed because--in common with the east coast main line--the greater part of that longer route satisfies the criteria. All other UK rail routes represented on the rail TEN are shown in the draft rail TENs map as conventional routes. I am informed that the Bristol-Penzance line has a maximum speed capability,on parts of it, of 110 mph, and therefore does not fall within the criteria.
The rail TEN, in common with the other transport TENs, is indicative, and does not place any financial or other commitments on member states to complete or upgrade existing rail infrastructure. In other words,the existence of any route on the rail TEN--whether high-speed or conventional--does not compel the UK to bring forward any specific investment projects. However, infrastructure investment projects proposed by member states on routes represented on the rail TENs maps, of whatever classification, will be eligible, in principle,for assistance from the Commission's TENs budget.
The UK rail map agreed at the June 1995 Transport Council includes all the major links to the south-west of England, albeit as conventional routes, so projects on those routes would be eligible, in principle, for EC funding. I must emphasise that TENs funding for any project is limited to 10 per cent. of the total project costs, and that the overall TENs budget is comparatively small.
I do not know whether it was a compliment or a criticism when my hon. Friend the Member for South-East Cornwall drew comparisons with my skill at cricket--I certainly have no such skill. However, I assure him that, even when I appear to be playing with a very straight bat, I listen to what people tell me, and take appropriate action afterwards.
I have been impressed by representations from my hon. Friend and many other hon. Friends that the case for upgrading should be examined. I have therefore recommended, and my right hon. Friend the Secretary of State has approved, a bid for TENs funding towards a feasibility study, which will consider investment options on the Great Western lines for both passenger and freight traffic. I hope that my hon. Friends will accept that that is a positive step--much more positive than simply getting out a marker pen and changing the colour of a line on a map. It is a positive step towards securing the improved rail infrastructure to which they aspire.
I want briefly to deal with some of the comments about roads. I was intrigued by the notion of key routes. I just wonder what they will be called if I deliver them.
Madam Deputy Speaker (Dame Janet Fookes):
Order. We now move on to the next debate.
Ms Dawn Primarolo (Bristol, South):
I am grateful for this opportunity to raise the difficulties and the appalling situation that has developed in Bristol as a result of the Government's policy. In this short debate I want to cover what is happening with oncology services in Bristol, why it is happening and the consequences for patients. I also want to deal with Government policy in respect of the Calman committee recommendations and the conflict between those and the funding package that the Government put together and give to Avon health authority. I then want to make three suggestions on how to deal with the crisis.
On 15 February, in an article under the heading, "Cash blow to cancer ward", the Western Daily Press said that dying cancer patients were being denied the radiotherapy that they needed and that they were being turned away from the oncology centre. That day, the Minister of State was in Bristol and when questioned about the crisis he said that it was a little local difficulty--a temporary financial difficulty that would be sorted out by the local health authority. I shall want to return to those comments.
I was home in Bristol by Thursday evening and was able to see the Bristol Evening Post, which carried harrowing interviews with family members of patients who are dying from cancer and who have been turned away from the centre. One incident that I especially remember related to a mother speaking of her 37-year-old daughter who has ovarian cancer and who was turned away from the radiotherapy centre. Her mother found her at home, on her haunches, reeling with pain and without proper pain relief. She was in desperate need of a bed in the oncology centre, but she was told by the centre that its beds were closed because of a financial crisis and therefore she could not be admitted.
We are supposed to have a national health service.We are supposed to be able to provide members of our community, wherever they live, with the same treatment and access to treatment. Yet in Bristol patients are being denied treatment simply because of where they live.
Ms Jean Corston (Bristol, East):
No doubt my hon. Friend, like me, will have received letters from constituents who are intimately and directly concerned with the cash crisis. I have received letters this week and one in particular was very moving. It refers to the fact that the unit in question is the main cancer centre for the south-west of England and it states:
Ms Primarolo:
I am grateful to my hon. Friend for her intervention. I, too, have received many letters from family members. I know that the staff at the oncology centre in Bristol are under tremendous pressure and stress because of the appalling situation in which they find
The Bristol Evening Post editorial, on 22 February, sums up very well the problems in Bristol--although the funding crisis is not unique to Bristol. Specialist facilities across the country are experiencing similar difficulties as we move towards the end of the financial year. The editorial said:
The other hospital in the city announced a few days later that it would close a quarter of its acute paediatric beds because of a cash crisis. We have a national shortage of acute paediatric beds, and yet a health authority is being forced to close a quarter of its beds. The editorial continues:
I can think of none. In the health service, that practice is particularly repugnant.
The staff at the Bristol oncology centre have been working overtime without being paid. They are totally dedicated to providing that service, and they are distraught that one of the five radiotherapy machines has been decommissioned and that staff members are being required to go elsewhere. They are desperate that the treatment--which they know will relieve pain, assist patients and is available in the hospital--is being denied. The NHS is failing people in their time of need.
A general practitioner wrote to me, on behalf of many of her colleagues, to express how appalled they were at the prospect of terminally ill patients being denied proper pain relief and being sent back into the community without proper support. For those GPs, that practice exemplifies how appalling are the reforms that the Government have introduced into the health service, converting planning and strategic decisions into rationing and competing management priorities.
The background to the problems in Bristol and its oncology centre is basically an increase in the number of patients who need treatment. There are three main reasons for the increase. First, people are living longer. We should celebrate that, but the incidence of cancers is of course also greater. Secondly, there is greater opportunity to treat people more effectively with new technologies, particularly new drugs. Those new treatments were not previously available for, for example, patients with breast cancer or bowel cancer. Thirdly, because the Bristol oncology centre is a regional centre, it receives more
referrals to its expert facilities. That is a result of the Calman committee report on cancer, which was endorsed by the Government, which recommended that people should be treated at the appropriate centre as quickly as possible with the most effective treatment.
The financial crisis in Bristol has been building up during the past four years, and it is not temporary. Despite extra money from Avon health authority, it still finds itself with a £500,000 overspend. The discussion about whether terminally ill patients should receive pain-relieving treatment is only the beginning of the debate. The current budget cannot be balanced without discussions on further rationing.
The discussion in Bristol and Avon is now about limiting the number of patients, because the allocated money can pay for only X number of patients to have access to the facilities and, once that number has been reached, no one else will be treated in Bristol. Where will those people go? Who will treat them, and at what additional cost, to them--in terms of a decline in life style and life opportunities--to their families, probably to the health authority and inevitably to the Government?
We are faced with the proposition that a regional centre in Bristol, which is funded by money from Somerset, Dorset and Gloucester--because it treats patients from those places--and from Avon, will be able to treat patients from Somerset, Dorset and Gloucester because their health authorities have more money and will be able to pay, while patients from Avon who have more serious cancers will be turned away simply because of geography. How is that a national health service? Is that an equitable distribution of resources? How will Conservative Members who represent seats in Avon explain to their constituents why they cannot have treatment, while someone down the road in Somerset, Gloucester or Dorset will be able to?
Avon health authority has said that no more finances are available and that the cupboard is bare. It cannot help the oncology centre. The authority has had a meagre increase in its budget for next year, and it has competing demands. It would have to consider cutting services for orthopaedic patients, children or kidney patients to maintain cancer services. That is not acceptable, and we will not tolerate it.
The authority said that it may have to look for alternative treatments that are not as successful or turn people away. That is more work for district nurses, more work for GPs and more work for the families, who are left with family members who need more support and who are in desperate pain, with a declining quality of life.
I asked the oncology centre in Bristol to tell me how much treatment costs, because we must look very carefully at the fixed and the variable costs of treatment. People there told me that a palliative course of treatment for pain relief costs, on average, £500 per patient, while it is £1,000 per patient for a curative course of radiotherapy treatment. Are the Government seriously suggesting that a person's dignity and quality of life are not worth £500 and are not worth finding the extra money? I sincerely hope not. From the letters that I have received from Avon health authority and the trust, and from the discussions that are going on in Bristol, it is clear that we could have further and severe rationing in the service.
That takes me to the proposals of the Calman committee report and the conflicts that arise from it. The report is excellent, and lays out clearly how cancer services should be provided and co-ordinated to include GPs, community hospitals, small district hospitals and tertiary referral centres such as Bristol. I wish to quote a few examples from the summary of the report's recommendations and action points. The summary says:
The Government have endorsed that recommendation, and I agree with it. There should be a bracket afterwards, however, saying "(except for Bristol)" as that quality of service is not being provided in the area.
The summary continues:
Those needs are the primary concern of the health authority and of those providing the services, but not of the Government who hold the purse-strings. Despite endorsing the recommendations in the Calman report, they are not providing the money that is needed to support the centres.
The summary continues:
That is exactly the strategy that the Bristol oncology centre has pursued. Its services are linked with the Royal United hospital at Bath and with Weston-super-Mare, where consultants are based. Yet the centre is being penalised and not rewarded, and staff face the appalling prospect of having to explain to patients why they cannot have the treatment that they need.
The summary states:
That is exactly what the Bristol oncology centre has done. The summary adds:
That is what the Bristol oncology centre is. The summary continues:
Exactly that type of network has been built up around the Bristol oncology centre.
That is exactly what is being denied the people of Bristol.
Those recommendations were followed up by a circular from the NHS executive dated 21 April 1995 which stated that the Secretary of State accepted the report's recommendations and welcomed the aim of delivering a uniformly high level of cancer care based on a network of expertise. Has the Secretary of State forgotten where Bristol is? Has he forgotten that the word "uniformly" means that people everywhere should have the same access? It is a desperate state of affairs.
At the heart of the matter is the unfair and unscrupulous way in which the Government manipulate funding to local health authorities, and it is to that subject that I will turn in my closing remarks. Money is not allocated to health authorities on the basis of equity. The weighted capitation formula, which allocates money to Bristol, is mediated by the market forces factor, which removes from Bristol and Avon £25 million of resources.
The Government remove that money--having decided that we do not need it--and give it to other areas. They came up with the incredible formula by dividing the country into four zones--zone one is inner London, zone two is outer London, zone three is the rest of the south-east and zone four is the rest of England, including Avon. This year, the Department of Health rejigged the weightings for zone four, but it was purely a cosmetic exercise and exactly the same relationship exists.
In a letter from M. A. Harris of the NHS executive finance and performance directorate to my hon. Friend the Member for York (Mr. Bayley) dated 5 July 1995,my hon. Friend was told that the staff pay index--or market forces factor--will continue to operate. The Government assume that average wage costs in the first three zones are above the national average--although that bears no resemblance to actual wage costs in those zones--and therefore authorities in those zones need more money. The Government find that money by cutting the budgets of all the health authorities in zone four by6.5 per cent.
The problem is that the average wage in Avon is above the national average, not below it. We are therefore in the perverse position that East Sussex--whose average wage costs are considerably below the national average--gets more money for its services than Avon, where the costs are above the national average. On the figures for the current financial year, had Avon not been cheated of that 6.5 per cent., we would have had an extra £25 million to spend in the Bristol and Avon area. If that had been the case, the oncology centre would not have a financial crisis and Southmead would not have to close its paediatric centre. We would not be facing the end of the welfare benefits advice that is currently given, and there would not be a cut in preventive health care strategies. There would be no cuts in physiotherapy, and patients would not be told to wait six to nine months for urgent physiotherapy. Instead, we would be seeing a development of these services. Before anybody talks about bureaucracy in Avon health authority, I shall put on record that it has one of the lowest levels of administrative costs in the entire country. It is an efficient and effective health authority.
I want to know what the Minister is going to do about the problem. First, will he today make emergency funds available from the Department of Health--as has been done in cases in London--to help the oncology service in Bristol through its current problem? Secondly, will he institute a departmental inquiry into why the current situation arose? Why has the Government's strategy for cancer treatment, as exemplified by the Calman committee report, been undercut and destroyed by the current policy of the Government on allocating funds?I would also like to ask for an emergency review of the market forces factor. If health authorities are to receive extra funding on the basis of wage costs, they should do so on actual wage costs--not some mythical figure that discriminates against other health authorities.
The professional workers--the nurses, doctors and support staff--in the Bristol oncology unit should have the last word on behalf of the patients. They recently wrote to the chief executive of Bristol royal infirmary
12.54 pm
"My colleague's wife has this week had her pain relieving treatment delayed due to the lack of money and is unaware of when she will actually receive this treatment. It is appalling and immoral that this can be allowed to happen.
This is an indiscriminate and debilitating disease that can affect anyone in my family and yours at any time! The thought of having to stand by and watch one of my family in excruciating pain when there are the facilities there, quite frankly appals me."
"Terminally-ill cancer sufferers are being turned away from treatment at the Bristol Oncology Centre; beds usually used for seriously ill children stand idle in Southmead Hospital".
"if ever there was evidence of a National Health Service in crisis we have it here and now in our area.
What we are experiencing, in the most dramatic fashion, is the 11-month health service. In other words: don't fall seriously ill in March.
It appears as though cash-limit budgets were set and those figures are being reached before the end of the financial year--so the work stops.
Everyone in the health service is desperate to provide the best possible care for those with the greatest need.
It is impossible, however, not to use emotive words when the dying and seriously ill children are so clearly victims.
Lack of funding, top-heavy management and bungling bureaucracy are all blamed.
In what other area of service or business would you simply cease production if budgetary limits had been reached early?"
"All cancer patients should have access to a uniformly high standard of care."
"The needs of patients and their carers should be the primary concern of purchasers, planners and professionals involved in cancer services."
"Cancer Centres and Cancer Units should be established to provide an integrated network of cancer care. Effective communications between components, including communication between Cancer Centres are vital."
"There should be a clear understanding of appropriate referral and follow up patterns between General Practitioners, Cancer Units and Cancer Centres."
"Radiotherapy should normally be provided in a Cancer Centre".
"In exceptional geographical circumstances it may be necessary to continue to provide radiotherapy in Cancer Units closely linked to Cancer Centres".
"Palliative care and symptom control should be available at all stages of a patient's illness."
"to make it clear that we also share the view that it is impossible to save significant amounts of money by service reduction in this financial year, it is also impossible equitably to restrict the service offered to the population of Avon Health in future years . . .We feel that the service that we provide is a normal standard oncology service provided by any regional centre"
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