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Mr. Michael Fabricant (Mid-Staffordshire): Does the hon. Lady recall that, when the Labour party was in power in 1977, it cut nurses' pay? Does she recall that in 1978 and 1979, sheets in hospitals--yes, including in children's hospitals--were not being cleaned because of the winter of discontent? Is that the legacy of which she is so proud?
Mrs. Wise: If the hon. Gentleman chatted with any nurse in his area, he would find that a different comparison would be drawn. Nurses may not be going on strike collectively, but they are doing so individually by leaving the service. Has the hon. Gentleman ever chatted to a nurse and had that nurse tell him about the times when she has gone home and cried because of the inadequacy of the service that she was trying to provide? If he has not had that experience, he has not talked to many nurses.
Mrs. Marion Roe (Broxbourne): I listened very carefully to the points made by the hon. Member for Peckham (Ms Harman), who, unfortunately, is just leaving the Chamber, but I totally disagree with her. Patient care in the national health service is most certainly not dominated by bureaucracy. To maintain that argument does a great disservice not only to the very good managers of the national health service but to the improvements in patient care that have been made since the advent of the national health service reforms.
The taxpayer surely has every right to expect that public money is spent wisely and that it is committed to achieve the ends that Parliament considers most vital. It is simply common sense that, in an organisation the size of the NHS, that requires strong leadership and robust financial control. That is the role of NHS managers. I believe, along with many others, that the many recent achievements of the NHS would not have been possible without them. The achievements to which I refer have not in any sense been attained in an ivory tower; they are solid, demonstrable improvements in patient services. I shall give a few examples of such achievements by citing what has occurred in the two hospitals that serve my constituents.
Over the past five years at the East Hertfordshire NHS trust, which operates at the Queen Elizabeth II hospital in Welwyn Garden City, there has been a 30 per cent. increase in the number of day cases and in-patients treated, including a 14 per cent. increase in emergency admissions. Over the same period, more than 33 per cent. more out-patients have been treated. Accident and emergency attendances have increased by more than 5 per cent. a year since 1991, but with the recent introduction of assessment units for children and GP-referred patients the trust has managed to control the number of unnecessary and, of course, costly emergency admissions.
For patients awaiting routine surgery, there has been a huge reduction in overall waiting time. On 31 March 1993, almost 600 people had waited longer than 12 months for their operation, but on 31 March 1996 only one person had waited longer than 12 months. That patient was admitted in early April. The appointment of many new consultants enables the trust to provide a very wide range of services locally so that patients do not have to make the tiring and often stressful journey into London.
Since 1991, a range of new units and services has been planned, built and put into service. They include a new day surgery unit that performs operations for more than 7,000 patients a year, the joint development of a magnetic resonance unit providing a state-of-the-art diagnostic imaging service, a new residential and respite care unit for younger physically disabled people, a pre-discharge unit for elderly patients awaiting assessment for longer-term care, a stroke rehabilitation unit, a complete new hospital ward for gynaecology patients and a high-dependency unit for coronary care and other serious medical conditions.
That is typical of what has been achieved in east Hertfordshire since the introduction of the NHS reforms. Those who are familiar with the funding of health services in the shires will be well aware that it was certainly not the result of over-generous funding. While all those developments were taking place, the revenue funding available to east Hertfordshire rose by only 3 per cent. It is
a superb record of efficient management and it equates to an efficiency gain of 22 per cent. in total or 4 per cent. on average each year, which well exceeds the national target of 3 per cent.
I am aware that those major advances in patient services are reflected throughout the country. They have been achieved not through bureaucracy but through skilled and effective management. Therefore, it must be clear that prudent investment in good managers pays dividends.
Those achievements have been attained against a background of low management costs. In 1996, East Hertfordshire NHS trust recorded management and administration costs of 5.7 per cent. of its overall expenditure. That low total would be the envy of many organisations with far simpler remits. However, we must not forget that many doctors, nurses and technical and professional staff are involved in the management of the NHS, and that is exactly as the taxpayer would wish. Of the 5.7 per cent. that I have just quoted, 1.7 per cent. relates to staff with a clinical or technical function.
Similar successes have also been achieved in the Chase Farm Hospitals NHS trust, which operates from Chase Farm hospital. Management of the trust is based around 12 practice management groups--the local version of clinical directorates, which were introduced in 1991--based on the major specialties. Each is headed by a PMG chairman who is a senior consultant in that specialty. PMGs are responsible for the quality of services, financial management, staff management and development and planning service developments through the annual business planning process. PMGs make budget and day-to-day decisions about services, so many important decisions are made at the chalk face rather than in the boardroom. About 50 per cent. of the full-time consultants are directly involved in management and there are excellent working relationships among medical, nursing, management and other professional staff.
The past three years at Chase Farm have seen the development of new, innovative services and the appointment of 14 new consultants, with additional consultant posts in general surgery, oral and maxillofacial surgery, obstetrics and gynaecology, anaesthetics, paediatrics and accident and new consultant appointments in orthopaedics, ear nose and throat and medicine.
The Chase Farm trust also places the highest priority on developing relationships and communications with GPs and various important initiatives have been developed. There is a GP forum, which is an open meeting for GPs that is held every Sunday morning. Farmfacts is a newsletter specifically for GPs and practice staff. Regular contact has been established with individual practices and doctors and managers visit GPs in their surgeries to focus on specific issues. There is a medical director helpline, which provides a regular time when the trust's medical director is available for GP queries, and there is also a GP adviser to the trust who attends all the board meetings.
Through its relationships with GPs the trust has developed services much closer to patients' homes. For example, there is a consultant-led clinic in my constituency at the Cheshunt community hospital as well as numerous GP surgeries. Those initiatives are the result of discussions between consultants and GPs about the services that they require for their patients.
Another recent innovation is allowing a consortium of Cheshunt GPs to use the community hospital as a base for their out-of-hours service.
Clearly, it is important to take account of every member of staff in the hospital who is involved in its management, but many managers retain significant clinical responsibilities. They include the chief pharmacist, the chief physiotherapist and other senior professional and technical staff. The medical director is a busy surgeon who fulfils his management role in four weekly sessions.
It is an inescapable fact, however, that the NHS internal market, which has been in operation since 1991, has incurred some elements of bureaucracy that could be dispensed with by carefully targeted action. For example, we need to examine whether staff time should be taken up with issuing invoices and checking queries. There may be scope for simplifying the system--a task that my right hon. Friend the Secretary of State has well in hand through the major efficiency scrutiny that he has launched in the NHS.
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