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6.10 pm
Sir Sydney Chapman (Chipping Barnet): I am grateful to be called to contribute to the debate and it is a pleasure to follow the hon. Member for Southwark and Bermondsey (Mr. Hughes). I agree with some of his points and disagree with others, but at least he always makes a thoughtful contribution. Sadly, the same cannot be said of the hon. Member for Islington, South and Finsbury (Mr. Smith), who led for the Opposition.
Millions of people are treated by our NHS every year and there are bound to be failures and justifiable complaints; however, I fear that the hon. Member for Islington, South and Finsbury was selective in his use of complaints and figures. I shall be selective in my use of NHS statistics so that I can at least give people the other side of the story, which is that, by and large, our national
health service is an outstanding success. It treats more and more people every day; more and more funds are committed to it; and there are more nurses, midwives, doctors and dentists serving it than there were when the Labour party was last in power.
I do not know whether we spend a smaller percentage of our gross domestic product on the NHS than other countries. If so, I suspect that it has something to do with the fact that most of those other countries have a greater proportion of private, as opposed to public, health care schemes. In the last five years of the last Labour Government, the percentage of GDP spent on our NHS went down from 4.8 per cent. to 4.7 per cent. Since the Conservatives were returned in 1979 the amount spent has increased from 4.7 per cent. of GDP to 5.8 per cent.--a commendable trend.
Rev. Martin Smyth (Belfast, South):
I can confirm that we spend less of our GDP than other countries, but two aspects must be borne in mind: first, that other countries, including the United States and France, spend more on insurance and bureaucracy; and, secondly, that overall we receive a better return on the money that we spend.
Sir Sydney Chapman:
I am sure that the hon. Gentleman is correct.
If we take inflation into consideration--I concede that it is inflation measured by the retail prices index--when considering the funding of the NHS in the last five years of the last Labour Government, we find that it was cut by 2.7 per cent. We can contrast that with the increase under the Conservative Government--albeit over the longer period of almost 18 years--of 74 per cent.
The number of in-patient treatments has risen dramatically. We should call such treatments episodes, because they do not necessarily relate to different patients and we would be in trouble if more than 10 million people--almost one fifth of the total United Kingdom population--had had to have NHS in-patient treatment. The number of NHS case episodes has risen from about 6 million a year when the Labour party was last in government to well over 10 million a year now.
Waiting times fluctuate. There is always greatest pressure on the NHS at this time of the year and I do not doubt that waiting times have gone up, which should concern to us all. However, the hon. Member for Southwark and Bermondsey was correct to say that waiting times went up during the stewardship of the last Labour Government. They started to go down under this Government and generally go up and down. I join my right hon. Friend the Secretary of State in saying that what really matters is not the numbers on the waiting lists, but the length of time before patients receive their treatment. Those times have risen recently, which gives cause for concern--but they have sometimes gone down.
The hon. Member for Southwark and Bermondsey is committing his party to more expenditure on the NHS, as we are, but he is committing a specific amount for specific projects. In the mid-1980s, the then Prime Minister decided to commit a huge sum to deal with patient waiting lists--at the back of my mind I have a figure of more than £1,000 million. She committed that money mid-year to the whole of the service, including efforts to tackle the problem of waiting numbers and lists. For a few months,
the policy succeeded and the numbers decreased, but it was not many months before the numbers started to rise again.
Pay is better for those who work in the NHS. It may not be sufficient, particularly for nurses, but let us remember that nurses' pay has risen 70 per cent. in the past 18 years. If their pay is insufficient now, it must have been even worse in the dark distant days of the last Labour Government.
The elderly are better cared for. I do not say that with complacency; the elderly need even more care, as do the mentally ill, but there are better provisions for them. The right hon. Member for Manchester, Wythenshawe (Mr. Morris) has contributed to the debate: I pay tribute to him for the work that he has done for the disabled and I appreciate the tribute that he paid to my former colleague, Sir Hugh Rossi. The hon. Member for Monklands, West (Mr. Clarke) and my hon. Friend the Minister for Social Security and Disabled People deserve credit for what they have done for the disabled. If we take into account inflation as measured by the RPI, funding for the disabled--by that I mean not only disabled people, but the long-term sick--has quadrupled. More needs to be done, but much has been done by the Government and I give them credit for that.
There has also been a massive building programme. At my latest count, the Government have been responsible for completing about 750 NHS building projects with a value of £1 million or more. Statistics conceal many things, but it is worth saying that the amount of funding for the building programme--for capital investment schemes--has gone up 66 per cent., or two thirds, since 1979. The record of the previous five-year Labour Government was a cut of no less than 28 per cent., taking inflation into consideration.
In Hemel Hempstead--metaphorically, if not literally, down the road from my constituency--the last Labour Government cancelled the new hospital building programme. Since 1979, that programme has been restored and has been more or less completed. As has been mentioned, Barnet has been waiting for a new hospital for 50 years under successive Governments. It was about to go ahead and was then cancelled by the health Minister in the last Labour Government. At long last it has gone ahead and phase 1A of the redevelopment of Barnet general hospital, costing £33 million, is due to open next month.
I do not want to sound complacent, but I believe that, all in all, the Government's record is commendable and is a good record on which to build. Of course there have been problems. My right hon. Friend the Member for Wealden (Sir G. Johnson Smith) mentioned the escalating demand for treatments, which has hugely increased, and the aging population. Another factor is the cost of new medical technology. In short, we have been spending more on the NHS, but we need to spend an ever-increasing amount because the population is getting older. By definition, the very young and the very old need NHS services relatively more than others. An increasing number of treatments and new types of operation are being introduced, which are very expensive indeed. There are tremendous challenges ahead.
As I admitted, there are failures from time to time. I know of a lady who went into hospital not once, not twice, but three times for an operation. The matter is the subject of an inquiry at the moment. Before she could have her operation, she needed pre-medical treatment which could be carried out only immediately before she had the operation, not a few weeks before. She received the pre-medical attention, but it was then found that a bed was not available--probably because a more urgent case had come in. The hospital was not in my local health authority but in the next-door health authority. I am confident that those who run those services will learn from that failure.
The best-laid plans go wrong. We may find that the weekend of 3 January to 5 January 1997 was the worst weekend for the national health service in its 50-year history, for many reasons. First, there always appears to be an increase in the number of people needing attention immediately after the Christmas period. There has been a flu epidemic, at least in my part of the country, and it is a sad fact of life that not only patients but nurses get flu, so there have been fewer nurses. The health authority tried to foresee that eventuality and plan for it, but the scale of the problem beat it.
Secondly, the question has been asked, why could not agency nurses be used? People choose to be agency nurses because they do not want to work full time as a nurse. They want time off, perhaps when their children are on holiday from school. That has been the problem and it must be overcome.
At least we have created and implemented a mechanism whereby people can complain. It is known as the citizens charter or, in this respect, the patients charter. We have therefore encouraged people to complain. We have set benchmarks for standard and adequate treatments and I hope that we can tighten those because 18 months is far too long to wait even for non-urgent treatment. That is a challenge to us all.
I want to try to counter what I believe to be the unjustified charge that has been brought by many people: that although we may be spending more on our NHS, far too much is spent on too many administrators. I have tried, albeit as a layman, to make a study of that subject in my locality. I take the opportunity to quote, not a politician, but Barnet's director of public health. In his 1996 report he says:
The Government have taken a lead in trying to reduce unnecessary or--I had better be careful--partly unnecessary bureaucratic costs. We abolished the area
health authorities in the early 1980s; we have recently abolished the 12 regional health authorities; we have merged the district health authorities and family health services associations; and I understand that we have reduced the central costs of the Department of Health.
That appears to be a pretty significant beginning, but the main argument against that would be that there are more managers at the sharp end--at district health authority level. I have inquired into that issue and want to make some points regarding my local health authority. The first is the obvious and important point in respect of clerical staff, not managers: I would prefer to have more clerical staff if that meant that consultants, doctors and members of allied professions working in the NHS could spend more of their time concentrating on their medical skills. It is not the number of managers or clerical staff that counts, but the amount of work that they do or that we expect them to do.
In Barnet, nearly half of those categorised as administrators or clerical staff work within clinical directorates, so they are probably not administrators but nurses. The question is: is a nurse manager a nurse or an administrative controller? In Barnet, they are mainly involved in nursing, but they look after some administrative control.
The proportion of NHS staff in Barnet who are administrators or clerical staff is slightly higher than in other health authorities. We have a slightly higher proportion of doctors and members of allied professions than do other health authorities, but that is because the acute services delivered by our health authority are provided on two separate sites, so more people are needed.
That leads me to comment on what may have been one of the most controversial decisions taken in our local health authority. The decision has assumed national proportions and was mentioned in an earlier intervention. This was the decision to close the accident and emergency department at Edgware general hospital to concentrate services on one site at Barnet. The Barnet site will be provided with an enlarged accident and emergency department, which is included in phase 1A. Why did the health authority make that proposal? Why did the then regional health authority and the then Secretary of State agree to it?
My view of this controversial matter is coloured by one of the most shocking statistics I have ever read. It came not from a politician but in a report issued a few years ago by the Royal College of Surgeons. It said that one in four deaths in accident and emergency departments are avoidable. As soon as I heard that, I made further inquiries. The statistic was confirmed in a report by Dr. Richard Warren, who examined the hospitals in what used to be the north-west Thames region. He came to the conclusion that there were 86 deaths a year in that area that could have been prevented but for the then prevalent structures for delivering A and E care.
Another shocking set of statistics comes from the British Orthopaedic Association, which has stated in a report that one in five patients are inadequately treated after major surgery in our A and E departments, and that one in eight are left with a severe avoidable disability.
The political problem lies in the fact that there is a popular misconception that any A and E department can deal with any accident or emergency. That is not true and
it never has been. The problem at Barnet general hospital and Edgware general hospital is that the acute services are provided on two sites about four miles apart, so there has never been adequate consultant cover. By concentrating the new, enlarged A and E facilities on one site, I have no doubt that lives will be saved.
It is of course difficult to persuade anyone living in the shadow of Edgware general hospital that the local health service will be improved by closing the local A and E department--indeed, I cannot prove that it will be, but from listening to expert medical opinion I am sure that the health service will be improved by the change. Not only will there be better A and E facilities, with more consultant cover, but there will be better ambulance cover, with two extra ambulance points in the Edgware region. People will be taken more quickly by ambulance to the new hospital as a result. What is more, every blue-light ambulance in my area carries, as of recently, a paramedic. I am told that the critical factor when dealing with a serious injury is not the time it takes for an ambulance to get to the A and E department but the time it takes before the person injured is stabilised by a paramedic on board a blue-light ambulance. I therefore urge the residents of the borough of Barnet and beyond who have hitherto depended on the A and E department at Edgware carefully to consider whether the new service will not be much better. I am convinced that they will find that it will.
"In fact, we"--
he is referring to the nation, not Barnet--
"spend less on management than any equivalent health service in the world."
If it is true that, as I believe, we are spending more today on management than we were a few years ago, that is not necessarily a bad thing. My local inquiries show that, in contrast with today, there was far too little financial accountability and much waste before we instituted our NHS reforms. I am not a qualified accountant, but I was appalled at the attitude in the Barnet health authority of yesteryear. I suppose that it was not unlike most other health authorities, as it expected to receive slightly more money every year without attempting to justify the increase by showing that existing funds were being spent cost-effectively, or that the increase would be used cost-effectively.
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