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Mr. Jacques Arnold: Will the hon. Gentleman give way?

Mr. Hughes: No, I will not give way because my colleagues are waiting to speak.

The sad fact about the Government and their changes is that market forces do not work in health care. The reality is that market forces driven by the Government are wrecking our health services. The truth is that our health service is not safe in the Government's hands and everybody except Conservative Back Benchers knows that.

9.1 pm

Mr. Hugh Bayley (York): I shall speak briefly about paediatric intensive care in Yorkshire because current provision is wholly inadequate. It is inadequate to the point that it is putting the lives of children at risk.

In the whole of Yorkshire we have just seven general paediatric intensive care beds to serve a population of more than 1 million children. It is one of the worst population-bed ratios in the country. Five of those paediatric intensive care beds are at Leeds general infirmary and last year it had to turn away 75 desperately ill children during the year, 61 of them during the winter months, because all the beds were full and none could be made available.

On 6 March the Secretary of State made a statement to the House about improvements that he intended to make to intensive care services. He promised that those extra beds would be in by the coming winter. The Yorkshire regional health authority carried out a study of the needs in our region and determined that three extra paediatric intensive care beds and six extra high-dependency beds were required.

The local purchasing authorities have agreed to fund just one of the nine additional beds which the regional health authority decided were required. That shows the consequences of the Government's NHS internal market working at its worst. Year after year of efficiency savings have forced hospitals to cut beds; but the pressure to cut beds is greatest on intensive care beds because they are the most expensive. That leads to the perverse result that the beds of which there is the severest shortage are the very ones needed for the most severely ill patients.

Earlier, my hon. Friend the Member for Peckham (Ms Harman) referred to the case of Nicholas Geldard. Let me remind the House briefly of what happened to

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him. He was a 10-year-old boy who was taken ill. His parents called an ambulance and he was taken to Stockport general infirmary. The casualty department decided that he needed a scan but did not have a scanner, so an ambulance was called to transfer the child to Stepping Hill hospital. It took an hour to arrive; by the time the boy got to Stepping Hill hospital the scanner had closed for the day. It operates only from nine to five. So it was decided to leave the scan to the following day. When the child became more ill in the night he was transferred to Hope hospital.

At the Hope hospital a brain haemorrhage was diagnosed and doctors said that the boy needed an immediate operation--but they had no paediatric intensive care bed. So they telephoned around the region, and then further afield, and eventually found a bed at Leeds general infirmary. So nine or 10 hours later the child was taken by ambulance over the Pennines through a snowstorm. When he got to the hospital and doctors examined him the child was found to be dead: he had arrived too late.

I have here a letter from Dr. Mark Darowski, the director of the paediatric intensive care unit at the LGI. He says:


I have written to the Secretary of State about the points raised with me by the LGI unit, asking two questions. I asked whether the right hon. Gentleman was satisfied that the one additional paediatric intensive care bed that our region is to get will be adequate to meet the need. Secondly, if he does not believe it adequate--he cannot believe that, given what he said to the House on 6 March--I asked him what action he and the NHS executive will take to override the internal market decision to supply only one additional bed, so as to ensure that the nine that are needed are provided.

Because I have given notice in writing of my questions to the Secretary of State well in advance of this debate, may I have an answer tonight from the Minister of State? Is one extra bed enough for the needs of desperately ill children in Yorkshire? If not, what will the Minister and the Department do to increase provision so that, contrary to the warning issued by the director of the LGI paediatric intensive care unit, there are no more desperate cases like that of Nicholas Geldard?

9.8 pm

Mr. Ken Purchase (Wolverhampton, North-East): I am grateful to hon. Members for allowing me a few moments in which to bring to the attention of the House a serious matter in my constituency. First it is necessary to provide a little background. But even before that I want to contradict one or two of the assertions made this evening by Conservative Members.

First, disregarding the changes in the administration of the health services that the Government have made, it must be remembered that the thousands of people who worked as administrators in our health services throughout the 1960s, 1970s and 1980s did an absolutely splendid professional job and deserve recognition for it. More of that in a moment.

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I abhor the suggestion that only general practitioners who have gone for contract holding are giving a good service to our patients. General practitioners, and those working with them in the health services, give their best--their work is of a tremendously high standard--whether they are on payment by results, whether they are fundholders or whether they are working under the old-fashioned rules of public service in the interests of patients. The balance should be redressed because some people pretend that there have been improvements in the health service only since these reforms. That is nonsense.

I shall refer to the way in which we have reached this point of additional bureaucracy in the health service. I--along with many other people--served in the health service on district committees and on area committees, and for no pay. We were proud to do so. In those days, we did not need the kind of reward that we see today--it is multiplied again and again on trusts and on other organisations that have been put together by the Government as part of the quangocracy. It is an absolute disgrace--there is no need for it whatsoever and it has not led to a qualitative improvement in any of the administrative services within the health framework.

I refer to competitive tendering. I wonder whether it will ever be possible for us to get a figure on the amount of money that has been spent on financial consultants. They allegedly helped the in-house teams put their tenders together and conducted the training that was necessary for them to promote their services. There was a business plan, and cash flow problems resulted therein. There was a change in the working hours and the practices that had to be undertaken. Thousands of pounds--if not millions of pounds--were spent on consultants who were offering so-called management advice.

The upshot of all this is that up and down the country the in-house teams are still doing the same work--and probably for less money in terms of the hourly rates and the salaries that they receive. In many instances, we have lost workers off the wards, particularly those who were cleaners in the hotel services. They have suffered tremendously as a result of that part of the Government's so-called reforms.

I refer to contracting out, particularly in the west midlands. Millions of pounds were lost in computer scams--contracting out failed miserably. It ultimately resulted in the ignominious resignation of the then chairman of the region, Sir James Ackers. He literally had to be forced through the door--there was a public outcry--because of the way in which he administered the Government's reforms in the health service in the west midlands. However, worse was to follow in the litany of waste that the Conservative Government thrust on the national health service. The Government had the temerity to pay this man to leave the health service--he was paid thousands of pounds in compensation. What an absolute disgrace.

Mr. Andrew Mackinlay (Thurrock): It is endemic.

Mr. Purchase: Yes, it is endemic. The Government filled the quangocracy with their friends, many of whom had no experience in the health service or in the ethos that underpins it. There has been one scam after another in Wales, in Scotland, in the south-east of England and in the west midlands.

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I draw the attention of hon. Members to the serious problem that we have in Wolverhampton in relation to the hospital services. This year, for the fifth year in a row, they have to find £2.4 million is worth of savings--equivalent to 3 per cent. The Government seem to think that efficiency savings can continue ad infinitum, but the savings have to be taken from a smaller total resource and many departments are already stressed because they have to provide an increasing level of service. They have been asked to treat the same number of patients for 3 per cent. less or to increase the amount of work they do, but this year, in Wolverhampton, the hospitals are being asked to find £2.4 million in cash by the NHS executive. That will be difficult, if not impossible.

I shall tell the House what will happen in Wolverhampton to meet that programme of cuts in services. Two intensive care beds out of a total of seven will close. That is not many to start with, but we will lose two. A day surgery unit will close for two weeks during August and two weeks at Christmas to try to recoup some expenditure. The main operating theatres will close for two weeks in August and at Christmas. Seven orthopaedic beds, six surgical beds, 10 gynaecology beds and nine neurology beds will be lost. The list goes on. Those closures will be made to meet the programme of cuts demanded by the Government and administered through the NHS executive.

The closure of an acute medical ward that specialises in the care of the elderly has been proposed and that will mean a reduction of 33 per cent. in the service. The freezing of posts is an old chestnut, but so many posts have been frozen for so many years that few or no posts are left that are not urgently needed. The quality of patient care is bound to diminish as a result. A further 11 posts in the operating theatres will not be filled.

That is the programme that faces my authority in Wolverhampton. The question is not whether the trusts are efficient or effective, because the health service has been run effectively and efficiently for as long as people can remember. I accuse the Government of misunderstanding the nature of what they call market-driven efficiency. We have seen year-on-year improvements in technology, management techniques and operating practices. Those improvements would have happened anyway.


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