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8.13 pm
Mr. Piers Merchant (Beckenham): I welcome the opportunity that the Opposition have provided today for a debate on health. There needs to be a serious debate on the dilemma, which all future Governments will increasingly face, of an almost limitless demand for new health provision, following more and more innovations, and the limited resources available. Unfortunately, the Opposition have ducked that debate. Instead, they have reduced the level of discussion to party political point scoring. That is a great pity, because that debate should take place.
The Opposition want to talk about all the things that they can find wrong with the national health service as well as a great many things that they cannot find wrong, but which they invent. The most obvious recent ploy has been to talk about bureaucracy because they think that will go down well with the public. The reality is that if they stripped out dozens of administrators, either it would be impossible to obtain an efficient use of resources or the clinicians would end up doing administrative tasks when they should be looking after patients.
The Government have been tackling the whole issue of bureaucracy, to try to keep it to a minimum. They have introduced a whole series of initiatives over the past few years: the abolition of the 12 regional health authorities--a whole tier of administration taken away, but a move that the Opposition opposed--the joining together of district health authorities and family health services authorities; the reduction in the number of health authorities in Wales; the requirement for a 5 per cent. reduction in administrative costs across the board; as well as the efficiency scrutiny teams that have quite literally cut out millions of forms. In my area, the Bromley Hospitals trust has saved £350,000 by streamlining its management operations through natural wastage, without affecting either clinical standards or staffing. It has done away with two director level posts to gain the greatest efficiency from the minimum number of administrators. That is the reality on bureaucracy.
I want to deal with a few of the issues that are of concern to real people. First, there is the issue of waiting lists. There have been waiting lists ever since the NHS started, but, quite naturally, patients want them to be kept to the minimum. That is precisely what the Government have achieved. Waiting lists have been reduced to their lowest-ever level. In fact, the last figures that I saw showed that the number of patients waiting more than a year for an operation had fallen to only 4,000--the lowest level since 1948. They also showed that 50 per cent. of all patients are treated immediately, a further 50 per cent. of the remainder are treated within five weeks and75 per cent. of the remainder within three months. In my area, Bromley Hospitals trust has reduced to zero the number of patients who wait for more than one year and its overall waiting list has come down by 25 per cent.
Secondly, all areas have benefited from new facilities during the past few years, not least the area that I represent. However, we are badly in need of a new acute hospital, as my hon. Friend the Minister knows only too well. The advance plan for a new acute hospital has reached the PFI stage and three tenders are expected by the end of July, with a firm business plan by October and a financial agreement by the end of the year. I hope soon to see the plan set in bricks and mortar.
That is being provided on top of the significant investment that has already been made--for example, a new day treatment unit that has resulted in a 25 per cent. increase in day cases. I visited the unit after it opened in March. It is an excellent unit that has been warmly welcomed by both clinicians and patients. At the local community hospital in Orpington, my hon. Friend the Minister's constituency, there has been a £2.4 million investment to upgrade its services. Last year in Beckenham, my constituency, £1 million was spent on new facilities for local people--a minor treatment unit, new diagnostics, a paediatric clinic, community health facilities, education and so on. All those have brought great benefit to local people. In May, there was a 16 per cent. increase over last year in patients being treated.
Thirdly, there were problems with accident and emergency facilities earlier this year, especially in January when there was an unprecedented level of demand. Like other health authorities, Bromley has taken firm action to deal with the problem. Between last September and March, waiting time in Bromley hospitals has been reduced by a third. In Bromley hospital itself, where the A and E unit is located, there have been a number of major innovations--a new consultant; minor treatment facilities that screen out people who do not need major A and E attention, which makes the system more efficient; two new wards; some specialised beds to look after people with the most serious illnesses and injuries; and a new observation ward. So major work has been done that matches investment into the three next nearest accident and emergency hospitals, all of which have benefited in the past year by investments of £1 million or more.
At Bromley hospital, £1.26 million will be spent on new investment this year and about £900,000 in the following year--all to improve the accident and emergency facilities. I am very happy that that problem, which should not have occurred but did, has been swiftly dealt with, the necessary money has been provided and the necessary investment has been carried out. I am sure that that is already delivering great benefits.
Developing and widening primary care is of the essence. I am delighted with the Government's approach to that--part of which, of course, is the extremely beneficial GP fundholding scheme. The widening of the scope of GPs' provision will not only satisfy patients, who would prefer services to be available from the GP whom they know, trust and can get on with easily and to whom access is easy, but take pressure off hospitals. It will take pressure off A and E departments because minor injuries can be handled by the GP, off consultancy services because they can sometimes be provided at the GP's clinic, and off diagnostics because, although much of it has traditionally taken place in hospitals, it can now be carried out by GPs.
Mr. Robert Ainsworth (Coventry, North-East):
I want to use this debate to raise two local issues that are causing great concern in the Coventry area. They are, first, the impact of the Government's policy, including the private finance initiative, on the hospital services in the city, and secondly, if I get time, health inequalities.
The Secretary of State said that the PFI had freed the national health service from short-term capital restrictions. Actually, what has been achieved is nothing other than delay. In 1987, Walsgrave hospital, the biggest hospital in the Coventry area, was identified as in urgent need of capital repairs. It is a 1960s building that looks fine from the outside, but, as hon. Members know, buildings built in that period cause some grave concerns. The hospital was in the queue for £20 million, but reorganisation by the Government, who insisted that there was far too much inefficiency in the NHS and intended to sort it out, put that capital allocation on hold, and the much needed work was not done.
We in the area were then told that, if the hospital applied for trust status, we would get the required capital. Walsgrave hospital did exactly that, and became a trust in the second wave. We cleared all the hurdles right up to political clearance at ministerial level for a £30 million capital allocation that was needed by the hospital. Then the Government changed the rules again and said that all capital must be referred to the PFI. Again, the capital allocation was cancelled.
Many good news stories have been generated during the process. We heard, "Good news--Walsgrave is in for a £30 million bid." Halfway through the PFI process, we heard, "Good news--Walsgrave is in for a £50 million bid." Now that we are down to one preferred operator, we hear, "Good news--Walsgrave is in for a £100 million bid." The proposed deal is basically for large land disposal, extensive development and 25-year control of clinical and non-clinical services. There is much to be commended, but some great concerns have been thrown up by a dilemma.
The second hospital in the city, Coventry and Warwickshire hospital, is on a central site. As part of the proposals--although those who are putting the good news spin on the story are trying to keep the two separate--the Coventry and Warwickshire hospital will all but close. My fear is that we will get the very worst of all worlds.
Birmingham central hospital was replaced by a minor injuries unit in order to offset public concern at the loss of facilities. It closed within a year. There is massive concern in Coventry that it will get exactly the same treatment. There is great public pressure to keep facilities in the city centre. It is a good location that is accessible to the entire city. I fear that we will get a minor injuries unit that will dissipate public concern and get rid of the
pressure. In order to push the main proposals through, we will wind up with an unviable facility that will close within a relatively short period at cost to the public purse.
The other concern among people is affordability. As I said, we are down to a single bidder in the PFI process, but there is a huge gap of millions of pounds--I cannot get the information to pin the figure down--between what is in the district health authority's budgets that would fund the PFI proposal and what the private sector is saying that it wants in order to make the scheme work. The public money is simply not there, unless the Minister is prepared to give assurances that there is an alternative public route to the necessary works at Walsgrave.
Alternatives are not available, so what on earth is going to happen to health service budgets in order to lever in the PFI proposal? What will be scrapped? What will be chucked aside? What savings will be made? What will it mean for the terms and conditions of people who work there? What will it mean for the actual service by the time the private sector has knocked it into shape to get the profit that it needs to fund the 25-year, £100 million proposal?
Another concern I have over the way in which the Government are operating the PFI, which all hon. Members are entitled to have, is about the process, and the lack of accountability. The proposed scheme in Coventry has come out at twice the original cost at the end of a nine-month process, during which, as a Member of Parliament, I have been offered access to the detail only on the basis that it is private and confidential, and that I share it with absolutely no one.
The chief executive of the community health council has been told by the chief executive of the Walsgrave Hospitals trust that the PFI is nothing to do with the CHC; it has no remit whatever to consider the PFI, despite the fact that the proposal will effectively set the scene for health service delivery in the entire city for many years to come. That is quite disgraceful. There are grave concerns about the loss of city centre provision and the affordability of the scheme. The last thing we want is a hospital that no one can afford to run or use, as I understand already exists in Solihull.
Will alternative funding be available? I want the Minister to say what control he is prepared to give up in return for the risk transfer. Even if we can shoehorn the proposal into the existing budgets, the private sector will not be prepared to accept the risks involved in running clinical and non-clinical services for a 25-year period without having total control.
Another issue, which I shall have to raise briefly because of the 10-minutes rule, relates to health inequalities. Much work has been carried out in Coventry to identify the scale of the problem there.
Earlier this evening, we discussed funding inequalities. Hon. Members know jolly well that proposals were made to ensure equality of funding across the nation, but they were rejected or amended by the Government in the most deplorable way. Although Coventry suffers as a result of funding inequalities, I shall concentrate on health inequalities.
Research conducted in Coventry some time ago, which has not been challenged, proves that, on average, men living in the more affluent parts of the city such as the
Bablake ward live nine years longer than men living in the Henley ward. Women in the Earlsdon ward live 10 years longer than women in the Henley ward.
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