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Mr. Booth: Does my hon. Friend agree that what is planned for the Barnet and Edgware hospitals will continue the success already delivered by the switching of serious cases from Finchley Memorial hospital to Barnet general, while our local hospital was kept open to serve the whole community in other ways?
Sir Sydney Chapman: My hon. Friend knows much more than I do about Finchley Memorial hospital, but I know he is correct. Moreover, he nicely anticipates my concluding remarks.
We fail the people of our country if we do not ensure that the delivery of health services takes into account increasing changes in medical technology. Those changes will mean decisions being taken that are, at least initially, unpopular. I presume to speak only for my own bailiwick and not for other parts of the country. I want to give Barnet health authority's members and the Wellhouse NHS trust a public accolade--they have received precious few tributes from anyone else--for having the courage to go for this new form of health delivery. I also pay tribute to the former regional health authority and to the former Secretary of State for agreeing to the plan.
The safest political option is always to leave things as they are, with a little more money all round for every part of the health service. We ought to be more sophisticated
than that. Next month, phase 1A of the redevelopment of Barnet general hospital opens, with an enlarged state-of-the-art A and E department and new maternity, gynaecological and obstetrics wards. I am even told that it has the largest day surgery unit of any hospital in Europe.
Mr. Jon Trickett (Hemsworth):
Listening carefully to the hon. Member for Chipping Barnet (Sir S. Chapman), I had the impression of a national health service being painted in rosy hues in the abstract, but whenever he moved from the abstract, or national, level to local examples, he seemed to reveal problems in his local health service. I want to deal with the particular this evening, not the abstract. I should like to describe some of the issues surrounding the health service in Wakefield district in my constituency.
The health service in Wakefield is in a state of crisis. The Secretary of State has said that we are bitching, carping and being negative in these debates. I say that we are describing reality. I want to describe what actually happens in Wakefield, not to paint an ideological picture of the NHS.
Incidentally, I pay tribute to the many practitioners in the health service who are struggling to do their best, often with great dedication and always with enthusiasm and commitment to the health service and to the principles of patient care. They work within a complex structure and must manage a difficult financial regime.
The information that I shall present to the House has been provided to me by practitioners in the local health service. It will therefore give an accurate picture as presented to me by administrators and clinicians, rather than a gloss that a politician might wish to put on the local health service.
According to the director of finance of the local health authority, the health service in the Wakefield area is facing a £5.8 million shortfall in funding. Such a figure is easily said, but the cuts that will have to be made in the next year will impact directly on the levels of patient care that my constituents and those of other hon. Members will have to put up with.
We have already heard about the effects of the iniquitous formula by which NHS money is distributed across the country. I shall spend some time describing how inequitably one element in the formula operates. I refer to the market forces factor--MFF--built into the formula whereby money is distributed across the nation. Hon. Members know the background to the MFF, so I shall not go into that. I shall concentrate instead on the impact of the MFF on Wakefield which, as I said, already faces a shortfall of almost £6 million in the next financial year.
I read from a letter sent to me by the chief executive of Wakefield health authority, who states that the impact in Wakefield will be significant,
According to the director of finance for Wakefield health authority, the MFF
I consider it an obscenity to suggest that a nurse, doctor, cleaner or administrator who is doing precisely the same job in almost identical conditions in Wakefield as in Westminster should be paid less. If we reflect on that for a moment, we shall see the immorality of introducing market forces arguments into NHS funding arrangements. Even if one accepts that, which I do not, it is impossible for the local health service to achieve the required reductions, given the fact that staff wages and conditions are negotiated nationally.
As a consequence, the health service in Wakefield has been given a target allocation some £5 million less than the allocation that it ought to receive in the next financial year. On top of the £6 million-worth of cuts that it is expected to make, the health service faces the objective of a £5 million reduction in funding.
In addition to suffering the inequities of the funding formula, Wakefield has been at the forefront--it has almost been used as an experiment--of other health reforms pioneered by the Government, which have had a serious and deleterious effect on the health service in our area. I refer in particular to fundholding practices. Until recently, the Wakefield district had twice the national average number of GP fundholders. Now we have reached 100 per cent: every single GP in the Wakefield district is a fundholder.
I am not opposed to the idea that GPs should have a leading role in determining the general pattern and structure of the health service. What worries me is that the extent to which fundholding has been introduced in Wakefield has resulted in an unplanned and non-strategic approach to health care provision. We are witnessing the emergence of small hospitals that carry out operations and provide other services that would normally be provided by the two general hospitals at Pinderfields and Pontefract.
Work is increasingly being taken away from the two general hospitals and provided in local hospitals established by GP fundholders. In my constituency,
a GP practice that is really a small hospital employs almost 100 staff. It purchases specialist and consultant care outwith the district. Consequently, the funding of the two general hospitals is being cut away, almost like a salami being sliced. The money available to the two hospitals is being reduced.
Anecdotes are passed round the district. Patients tell me that they have experience of GP fundholders sending patients by taxi from my constituency as far as Rochdale, for minor operations. A patient told me that he was sent by taxi to Manchester airport by a GP fundholder and flown to Glasgow for a relatively minor operation. The local general hospitals, which already face serious problems as a result of the underfunding of the local health service, face additional financial problems.
I am aware of GP fundholders in my constituency who are not only building small hospitals, but developing leisure centres with swimming pools and leisure activities, using the surpluses generated by savings in health care provision to local patients. Apart from the fact that patients are being taken away, so income to the local hospitals is being lost, I am worried that in the long term, that will affect local health care provision.
Today, an orthopaedic specialist told me that his local GP fundholding practice had acquired its own X-ray machines. Those X-ray machines were then serviced by consultants who had been brought in from outwith the district. When they looked at the X-ray machines, they found that they were inadequate for diagnostic work and therefore for the requirements of both consultants and patients. The orthopaedic and other consultants whom I met this morning told me to say that they are worried sick about the future of the health service in the Wakefield area.
It is clear from all that that the two general hospitals, Pontefract and Pinderfields, are under great financial stress as a result of both the formula, which is unfair to Wakefield, and the ridiculous experiments in relation to GP fundholding. The number of beds in our area has declined almost cataclysmically. In the Northern and Yorkshire region, the number of general and acute beds has declined by 20 per cent. As a result of that and of other processes, an increasing number of patients are suffering the anxiety of being taken almost to the operating theatre and then having their operation cancelled. In the last quarter, almost 2,000 patients in the Northern and Yorkshire area suffered the difficult and traumatic indignity of having their operation cancelled at the last moment. In the Wakefield area alone, more than 350 patients in the past year have had that experience. The hospitals in the Wakefield area are under siege because of a financial regime that declines year on year, an inequitable and unfair formula and the fact that the fundholding experiment has been taken to an extreme in our district.
"in that if the Market Forces Factor did not exist the funding arrangements to Wakefield would see its target allocation increase by approximately £7m, which would put us below target rather than 3.34 per cent. above target."
24 Feb 1997 : Column 68
Wakefield has the second lowest MFF in the NHS--only that of Rotherham is lower.
If one compares the MFF of Wakefield with that of the Westminster and the Kensington and Chelsea health authorities, the result is remarkable: those London health authorities receive 25 per cent. more than Wakefield. The explanation is that the MFF is calculated on the assumption that Wakefield is a low-wage economy. The health service in Wakefield is penalised through the sum that the formula allocates to the area, because our wages are supposedly so much lower than those of the Westminster and the Kensington and Chelsea health authorities.
"is calculated largely based on the fact that Wakefield has a low wage economy and should therefore be able to pay NHS staff at lower rates than elsewhere."
The director of finance goes on to point out that it is not possible to reduce local pay rates until a system of local pay bargaining is fully implemented. At that point, it might be possible to adjust relative pay rates. At present, 90 per cent. of staff in the health service are paid according to nationally negotiated conditions. The wages of the remaining 10 per cent. are the only element that local health service managers can manipulate in order to secure the differential that they are supposed to introduce in their funding.
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