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Mr. Barron: What does the right hon. Gentleman think?
Mr. Dorrell: I will tell the hon. Gentleman exactly what I think about the PFI. I think that it is the best opportunity that the health service has to ensure that it
escapes from capital short-term planning and delivers the modern equipment and buildings that we need to ensure that the NHS meets the challenges of the next century.
The hon. Member for Peckham has an opportunity to tell us her position. We do not ask her to take the opportunity today, but we ask her to take it tomorrow. I understand that she will go to talk to Unison tomorrow on the PFI. Unison's position on the PFI seems pretty clear from this advertisement, which states:
I conclude with a little advice to the hon. Member for Peckham. She would do well to back the Leader of the Opposition. In my humble opinion, the right hon. Member for Sedgefield (Mr. Blair) remains her best and only hope, because the fact is that Labour's health policy is a shambles. Labour Members have a slogan on the internal market, but they have absolutely no substance to back it up. They have no idea what they would do about fundholding. They have no idea what they will do about the PFI. Their policy on resources on health relies on a non-existent El Dorado.
The hon. Member for Peckham survives by the indulgence of the right hon. Member for Sedgefield, who demeans himself and his party by his unwillingness to face even one of the real issues facing the NHS. Where there should be substance, there is a vacuum. His speech to NAHAT last week was as trivial as it was content-free. Even the high spots last week were not so much soundbites as soundnibbles.
Mrs. Audrey Wise (Preston):
I want to raise two major points in the time available to me. One relates to fragmentation and the lack of co-ordination and the other to the bureaucratic nonsense of so many of the so-called activity and efficiency measures introduced by the Government.
I shall start with the latter, but before doing so I want to comment on the remark made by the hon. Member for Clwyd, North-West (Mr. Richards) about emergency admissions. He seemed surprised to find that we expect beds to be available for emergency admissions. I expect beds to be available and vacant, as needed, for emergency admissions, and I expect fire engines and ambulances to be standing waiting just in case I have a heart attack or
there is a fire at my home. I am obviously grossly extravagant in my expectations, but I can tell the hon. Gentleman that those expectations are shared by the overwhelming majority of the population.
The problems with bureaucracy go back a long time. One of its major manifestations is compulsory competitive tendering. CCT does not necessarily lead to the best value being obtained, but rather to trouble and expense being incurred in obtaining normal services.
Although I am on good terms with my local district general hospital and although I believe that those managing it are doing their level best in difficult circumstances, I want to give a small critical example of the sort of problem that arises. Cleaning is obviously basic in a hospital. A constituent drew my attention to a lack of cleanliness at the Royal Preston hospital at the turn of the year. I was very concerned about that. I had been a patient in the hospital, but before CCT was introduced. I can tell the Secretary of State that the hospital was sparkling then.
I investigated the problem and it was confirmed that there were difficulties. The chief executive said:
I know that many, many people in Preston are desperate for work. I do not believe that good employers cannot obtain staff for a job that is not unpopular. As cleaning jobs go, cleaning a hospital is regarded as very useful work that carries with it some sort of standing in the community. It is not a rubbish job--or it should not be. It is an essential job.
I was told by the chief executive:
I can tell the Secretary of State that I know of cases--not in the Royal Preston, but elsewhere--of apparent savings in supplies contracting. The only problem has been that the search for and the delay while waiting to identify those minuscule savings have more than swallowed up several years' cumulative savings. Again, that is not such a good idea.
Finished consultant episodes are now a measure of activity or efficiency in the NHS. I do not believe that they measure either of those--they certainly do not measure efficiency. Indeed, I have recently learnt that they do not even measure activity. Gimmicks or ruses are employed so that a hospital can show a massive increase in its activity through finished consultant episodes. It is very easy--the hospital simply discharges patients to whom previously it would have said, "Come back next
month." It now says, "Go to your general practitioner." The GP then refers the patient back to the hospital, but it counts as a new consultant episode. The hospital can then say that far more people are being treated. Finished consultant episodes do not equate to people being treated. That should be lesson No. 1 for any Secretary of State who wants to get real efficiency in the NHS. Some of the effort put into accountants chasing pieces of paper should be put into finding sensible measures of outcome in the NHS and treatment for patients.
I want to refer to the lack of co-ordination, especially in relation to child health. A report was published 20 years ago, having been commissioned by the then Government. It was one of the rare excursions by the powers that be into children's health--a subject that has been grossly neglected by the House and by successive Governments. However, 20 years ago the then Labour Government published the Court report, the essential plank of which was that there needed to be more co-ordination in the provision of a children's health service. We still do not have a children's health service. In fact, if any hon. Member cares to consult any voluntary organisation, I can promise that the story that that hon. Member will be told will be one of fragmentation, competition, lack of communication and general chaos, which in my opinion is not too strong a word to use.
It is deplorable that there should be quarrels between health services, social services and education services about who pays for what, while the children go without. A sensible Government would give more than a steer on who pays for speech therapy, for instance, instead of allowing it to be shunted between local education authorities and health authorities, while the children go without. I would not mind if the argument were being conducted on the side, at the same time as provision was being made, although I would still think that they should not put too much time and effort into the arguments. However, the children go without while the squabbles continue.
I am sure that, in general, voluntary organisations would echo an organisation called Aid for Children with Tracheostomies. It complains bitterly about difficulties in obtaining essential equipment, disposable supplies and respite care. All those are needed for children who are being nursed in the community, which is a growing trend. Along with that growing trend should go a growing provision of essential equipment, disposable supplies and respite care; otherwise, the children are being short-changed. Indeed, I do believe that children and their parents are being short-changed.
Respite care at home is a very good idea. Unfortunately, it is difficult to organise. It is hard to understand that because keeping a child in hospital for one night costs about £150, apart from any treatment costs. I am reliably informed that full respite nursing care for the equivalent period would cost £80--a saving of £70. One would think that all authorities would be queuing up to provide respite care at home, but no money for such care appears to have been built into the community nursing service budget. Therefore, a liaison nurse--assuming that there is one, which is quite a big assumption in some places--has to approach a GP and request that the GP puts in a bid for health authority funding.
My hon. Friend the Member for Peckham (Ms Harman) cited examples of bids being made for extra-contractual referrals. I am not too happy about the fact that a
community nursing service may think that respite care is needed for a child at home, but can arrange it only through a GP, who must bid--which presumably means that it may or may not be granted--for something that is not only better but cheaper. Despite that, the Government tell us that they know how to run the national health service.
There is a lack not only of respite care at home but of a community children's nursing service. Not only are children in hospital still as likely to be nursed in adult wards as they are in children's wards, but when they are discharged for continuing care at home, there is a 50:50 chance of there being no community children's nursing service in their area. That means that their care is not supervised by qualified children's nurses.
For the benefit of Ministers' education--if they will spare time from their conversation and listen--I should point out that it is a prime tenet of children's medicine that children are not simply small adults. They require very specialist care, yet in 50 per cent. of the country there is no community children's nursing service and only 10 per cent. of the country has a 24-hour children's community nursing service.
"PFI: the biggest threat to your health since 1947."
It has even designed a logo to encapsulate the message, which states:
"Unison says no to private finance."
The hon. Lady has to decide before the meeting--at 12.30 pm tomorrow, at the Cumberland hotel--whether she is on the Unison side of that argument or on the side of the Leader of the Opposition and the hon. Member for Rother Valley. The health service needs to know the answer to that.
"The problem relating to the cleanliness of the wards relates to difficulties encountered by the contractors in maintaining sufficient staff on the wards."
I wrote asking whether the contractors did not pay adequate wages. I was told that they paid the same wages as were usual and that any recruitment difficulties experienced from time to time were more to do with the local labour market.
"A meeting is to be held shortly with the director of the company with an expectation that the problems will be overcome."
The problem with that is that the meeting was scheduled to take place three months after the identification of the problem of lack of cleanliness. Three months is a long time to have cleaning problems in a hospital. That sort of problem arises not because of any inefficiency by the chief executive, but because he no longer runs the show. Other people employ those who are performing that essential service in the hospital. That does not lead to good management.
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