---

Mr. Nigel Waterson (Eastbourne): Can the hon. Gentleman confirm that in the dying days of the last Labour Government, which seems a long time ago, as indeed it is, the foundations were laid for the collection and collation of NHS statistics--for example, for finished consultant episodes? How can he therefore take issue with the basis on which the facts are produced?

Mr. Smith: I do take issue with the basis upon which many facts are produced. I have no particular quarrel with using a finished consultant episodes accounting mechanism, provided that it is made clear that it does not refer to the number of patients treated. That is the fatal conflation that the Government always make: they take the finished consultant episodes figures and, because they have increased, claim that the number of patients treated has also increased--ignoring the fact that they do not know how many patient readmissions form part of the finished consultant episode figures.

We have insufficient information about the level of NHS readmissions at present. We should have those figures, as they are good indicators of how well or how poorly patient treatments are working. However, that information is not held. The Government should be more accurate in their language, instead of talking breezily about patient numbers when they are really talking about the number of treatment episodes.

Mr. D. N. Campbell-Savours (Workington): I can speak from personal experience as I have been a patient in many hospitals over the years. In some hospitals, the readmissions figure can be as high as 20 per cent. on surgery wards. That is a substantial figure which totally destroys the credibility of any statistics produced in that area.

Mr. Smith: Absolutely. A major problem is that the internal market--to which I shall refer in a moment--places intense pressure on hospitals to get patients through as quickly as possible. Inevitably, that means that patients who enter hospital for a course of treatment are often sent home too early--particularly elderly patients who are unable to recuperate as quickly as younger patients. Such patients often receive no proper support at home and are unable to recover properly. As a result, they end up back in hospital four or five weeks later. That is wonderful for the Government's statistics, because they count that readmission as another patient, but the quality of care provided is not good and the overall cost to the health service is increased. That is one way in which the operation of the internal market acts as a distorting pressure on the system at present.

I said earlier that the Secretary of State does not seem to know what is happening in the health service. His lack of knowledge about the NHS is extremely revealing. My hon. Friend the Member for Dulwich tabled a series of parliamentary questions and received a bonanza of answers on 12 December 1996. They showed that the Secretary of State does not have a lot of basic information about the current nature and form of the health service.

For example, my hon. Friend asked about the number of acute hospitals in each health authority area. That is a fairly simple question. My hon. Friend the Member for

21 Jan 1997 : Column 753

Bolsover (Mr. Skinner) asked earlier about the number of hospitals that have closed since 1979. Ministers did not know the answer to that question, but perhaps they know how many hospitals the national health service comprises--after all, they are supposed be in charge of the NHS. However, we were told that the information "is not held centrally." When we asked how many community hospitals are in the national health service, the answer was the same. We asked how many ambulances are owned by ambulance services across the country--that is fairly basic information--but we were told that the information is not held centrally. We asked how many acute hospitals have been closed in the past five years--a matter of intense interest to many local communities throughout the country--but again the Government replied that the information is not held centrally.

Given the promises that the Secretary of State made last March on intensive care and on accident and emergency care, we asked how many intensive care units there are in each health authority area. We were told that the information is not held centrally. The Government do not know how many intensive care beds there are in each health authority area, or how many paediatric intensive care units or beds there are. They do not know the number of nurses who have ceased to practise in each of the past six years or the number of trusts that have cancelled elective surgery until the end of the current financial year.

The Government have placed every possible emphasis on the cost of operations in the health service and on how the internal market will sort it out, but they do not know the average cost of a hip replacement operation in England. Given all that the Secretary of State does not know about the health service, it is no surprise that he presides over a health service that is in such a disastrous condition.

The principal problem, of course, lies in the operation of the internal market, which has led to the fragmentation of decision making and directly to the problems in intensive care and accident and emergency services that we have seen in the past few weeks. It means that there cannot be the overall look that we need and which the hon. Member for Southwark and Bermondsey (Mr. Hughes) advocates. It has also led to a loss of beds--a fall of 24 per cent. overall in England since the changes were introduced. The chairman of the British Medical Association council laid the blame for that squarely on the internal market. Hospitals are downsizing their capacity to the minimum, rather like airlines double-booking many of their seats.

The internal market has also led to a distortion of clinical priorities. I will cite just one example--Glenfield Hospital NHS trust, in Leicester, which issued a letter on 7 January to local general practitioners. It is interesting to note that the letter was issued to GPs who are covered by health authority contracting. It was sent only to non-fundholding GPs. Fundholding GPs are exempt from the letter, which begins:

"After several weeks of negotiation, this Trust has reluctantly reached agreement with Leicestershire Health, Southern Derbyshire Health Authority and North Nottinghamshire Health Authority, to restrict services. With immediate effect, for Cardiology and Cardiac Surgery"--

we are talking about serious surgery--

21 Jan 1997 : Column 754

"only emergency patients and those potentially breaching the 12 month Patient's Charter guarantee, will be admitted. This restriction will apply until 31st March 1997."

This action is not being taken because of any wish to do so on the hospital's part. The letter continues, and this is the real sting in the tail:

"It does not reflect this hospital's capacity to treat patients. We have the capacity to perform all the work which GPs could refer to us".

Do we not live in a crazy world? We have a hospital which says that it has the capacity to carry out all the work that GPs in cardiology could refer to it. We know that there are patients who need treatment. Yet because of the procedures and rules of the internal market the hospital must close its doors to those patients. The internal market distorts priorities within the health service.

Mrs. Mahon: I spoke earlier about patients from Calderdale who cannot have their operations performed in Leeds. The letter from Leeds General infirmary reads:

"Your local health authority has found a suitable alternative hospital which is . . . the Glenfield Cardiac Unit in Leicester."

It would seem that patients from Calderdale who cannot get into the Leeds infirmary until after July will be taken to Leicester, where local patients cannot be operated upon because a restriction has been placed on their local hospital. That is mad.

Mr. Smith: My hon. Friend, whose information I did not know, redoubles the force of my argument about the absurdity of the way in which the market system that the Government have imposed on the NHS is distorting the manner in which the NHS operates.

The market system has led also to spiralling bureaucratic costs amounting to £1.5 billion a year. That is the British Medical Association's estimate, not one produced by the Opposition. That is the cost of the bureaucratic procedures of the internal market. That is why our proposals for the replacement of single-practice GP fundholding by locality commissioning, a move from annual contracts to three to five-year agreements, with agreements based on the process of co-operation rather than competition, an end to the system of individual invoicing and reducing to one tenth the number of contracts swimming around in the system, will all help to reduce the bureaucratic costs. The money saved can be diverted into patient care.

Mr. Nigel Forman (Carshalton and Wallington) rose--

Mrs. Margaret Ewing (Moray) rose--

Mr. Smith: I want to make progress because I have given way on many occasions. I shall, however, give way briefly to the hon. Lady.

Mrs. Ewing: Exactly how much money does the hon. Gentleman expect will come from the savings that he has outlined and how quickly will it move into the system? We have heard a clear statement from an Opposition Treasury spokesperson that there will be no additional funding. It is important that we know what is being promised by the Labour party and the time scale involved.

---