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9.18 pm
Mr. Cynog Dafis (Ceredigion and Pembroke, North): I shall be as short as possible, Mr. Deputy Speaker. However, I want to draw the attention of the House to the situation that has emerged recently in the Dyfed Powys health authority. Two days before Christmas, the health authority published a strategy document in which it made some swingeing recommendations. I believe that it published the document only two days before Christmas because it wanted to defuse the public reaction that it feared was inevitable. That reaction is now mounting and it needs to be taken seriously.
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The review is the outcome of a funding crisis that the health authority has for the moment. That crisis is being passed on to the trusts within the authority's area. The crisis has been caused by factors that I shall not take up now. However, the health authority reveals in its document--this part of it I believe--that it is underfunded because rurality is not considered significantly in the formula. It is a large region--the whole of Dyfed and Powys--and so needs four district general hospitals for a population that would need only two in an urban setting. Those hospitals are needed because of travelling distances.
The document states:
That is an appalling example of defeatism and a signal to the Welsh Office that the authority intends to do the business that the Welsh Office wants of it, which is to balance the books and cut services. In reality, we are talking only about cutting services. Let us not mince words about that.
The health authority reckons that it must pull back or save more than £11 million over the next four years. Accordingly, it makes proposals that are designed to achieve such a saving. First, it is proposed to reduce the number of trusts from eight to two or three. There is no problem with that in theory but the proposal raises the question why so many trusts were created only four or five years ago.
Secondly, it is proposed to close eight of 19 community hospitals. That is peculiar, given the endorsement from the Welsh Office in a document published only in August 1996, which emphasised the important role that community hospitals should play. I shall not quote at length from the Welsh Office document now, but another important institution in Wales, the Office of Research and Development for Health and Social Care, argues that community hospitals should or could be playing an enhanced rather than a reduced role.
It is clear that the health authority has not thought through its proposals for community hospitals. Its document states:
The third proposal is to reduce the range of treatments or specialisms at a number of district general hospitals in the name of centralising activity. It is claimed that that is necessary because of an increasing trend towards specialisation and that sort of thing.
In reality, if the range of specialisms at a place such as Bronglais were reduced, the status of the district general hospital would be reduced. Indeed, it would no longer be a district general hospital. It would not survive in a
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The content of the document is poor stuff. The paper is full of vague proposals that are based on unjustified preconceptions. Crisis management is masquerading as strategy, and that is unacceptable. If the proposals were implemented, decisions would be taken that in all likelihood we would be bitterly regretting five years later.
What is to be done in all the circumstances? Two things should be done now. If action is not taken, public reaction will justifiably be fierce. First, the health authority and the trusts should commission a properly conducted and objective study of the health care needs of Dyfed Powys. They should do so in association with the Office of Research and Development for Health and Social Care, which has expert knowledge and experience. It is in the business of building up a research understanding of health care needs in Wales. To that extent, I am much in sympathy with the Liberal amendment. The outcome of such an objective study, and the evidence that it provides, should be the basis of any restructuring.
There is a funding crisis and the Welsh Office could and should step in with £4 million per annum additional funding until 2000 when, according to the health authority, the situation would improve because the cuts resulting from the change in the formula would no longer apply. We need that kind of money. We need a proper approach to restructuring and a strategy based on evidence, and we need money in the meantime.
Ms Tessa Jowell (Dulwich):
This has been a necessary and timely debate, but not one that the Government wanted. On two occasions, my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) sought an emergency statement on the winter crisis, but the Secretary of State declined to make one.
The British Medical Association said that this winter's crisis is the worst ever, and it provided a catalogue of evidence in support of that claim. What was the Minister's response? On the radio--not in the House--he said, in effect, "This is the winter. What do you expect? Demand always rises in the winter." Of course it does, but we expect the Secretary of State to be ready for it. He should be ready for the 'flu, bronchitis and other ills that winter brings, and for the inevitable and predictable spate of accidents caused by icy roads and footpaths, not to mention the increased fragility of elderly people in freezing weather.
The Secretary of State and his colleagues have obviously been on a course at the Yorkshire Water school of management studies. Only there could they have learnt
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The Secretary of State will go on any radio or television programme at any hour of the day to tell a disbelieving public that there is no difference between Labour and the Tories on health. The Government believe that the market is the cure-all for the national health service. We shall get rid of the internal market. We shall keep commissioning separate from the provision of care, but co-operation, not competition, will be our approach, and it will work. That is what people who work in the health service want, because they know that that will begin to dismantle some of the obstacles that stand in the way of the delivery of best patient care.
As hospitals are forced to compete like businesses, so the purpose of their existence--the care and comfort of patients--is relegated. It is now commonplace for patients who arrive at a hospital to find that it is so short of beds--because they have been taken by emergency admissions--that planned operations have to be cancelled. Many of my hon. Friends have given examples of that problem. Other hospitals are so short of money that doctors, nurses and operating theatres work at below capacity, unable to perform operations until the next financial year. Increasingly, it is only the patients of GP fundholders who are able to have their operations before the end of the financial year.
The public are understandably mystified by this misallocation of resources--but not Ministers. Cancellation of operations and discrimination between patients on grounds other than clinical need are part of the ineffable wisdom of the market. It is the triumph of the ideologue, but the politics of the bargain basement.
My hon. Friends have given clear examples of the crisis. My hon. Friends the Members for Birmingham, Northfield (Mr. Burden), for Warrington, South (Mr. Hall), for Nottingham, East (Mr. Heppell) and for City of Durham (Mr. Steinberg) expressed concern on behalf of their constituents. Ministers have scorned the use of individual cases--and so would Opposition Members, if it were not that those cases illustrate the experience shared by so many others, and demonstrate the pressure on the service.
A 70-year-old man died in Sheffield after being ferried 90 miles from his home in the west midlands, where a bed could not be found for him. In London, 22 patients had to spend the night on trolleys at Kingston hospital, while patients awaiting treatment at Lewisham hospital have been told that they will not be seen until the end of the financial year. In Liverpool, 30 acutely ill patients were left waiting in a hospital corridor after a ward was forced to close. Those are the everyday stories of our national health service during this time of winter crisis. The examples that my hon. Friends and I have given, however, are not--as Ministers try to claim--what patients should have to expect from the NHS in winter.
The growth of bureaucracy has become a cancer in the operation of the national health service. According to the British Medical Association, since 1990 it has cost an extra £1.5 billion a year. That was entirely predictable, because every organisation has its own overheads. When organisations are competing, it is difficult to share, and each trust has its own director of staff, technology and
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Of all the fictitious slogans ever coined to mislead the public, none was more misleading than the one that proclaimed that the national health service was safe in Tory hands. What are the origins of the failure? First, there is the pace at which acute beds have been closed throughout the country, which has been described so clearly by my hon. Friends on the basis of their experience in different parts of the country, and which has given change such a bad name. For most people, change means less: it means that their local hospital will close, and that nothing will be provided in its place.
Secondly, the competition between hospitals that has resulted from the internal market means that, instead of co-operating, hospitals have become what they have aptly been described as--city states at war with each other. Thirdly, there is the demoralisation of staff who must push paper and fill in forms rather than tending patients and performing operations. That demoralisation is driving doctors and nurses away from the national health service in numbers that begin to threaten the service itself. Let me make it clear that Opposition Members draw a clear distinction between the bureaucracy that, like bindweed, consumes the efficiency of our national health service, and the importance of skilled and effective management, to which we pay tribute.
"there is a strong case for additional funding separately from a capitation basis for an area which has the scarcity of population and geographic area of Dyfed Powys."
The authority says in the previous paragraph, however, that it does not think that the Welsh Office will respond. It thinks that the formula will not be changed, and that even if it were, things might be made worse.
"We are prepared to discuss other options which would save the necessary money and provide effective services. In view of this, we are not being specific on the hospitals which close. We believe we have to work with our trusts".
It continues in that vein. It is clear that the authority is looking for cuts without having made a clear analysis of why community hospitals should be closed. On what basis has it made such a radical proposal--to close nearly half the cottage or community hospitals in the area?
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