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Mr. Congdon: I can quote two examples. The first was raised in an intervention by my hon. Friend the Member for Gillingham (Mr. Couchman), who quoted figures for 1994-95 showing a differential of £50 a week in favour of the private sector. Secondly, Kent university's public research unit has provided figures showing an average cost of some £410 a week for a place in a local authority home and, if my memory serves me right, about £220 a week in the private sector. It is a big differential. That is why I would argue that local authorities do not provide value for money. If that money were freed up, it could provide for more patients.
Mrs. Kennedy: The hon. Gentleman has made an interesting intervention. I listened carefully to the figures that he quoted and I will examine them after the debate. In my experience, however, the social services department in Liverpool effectively uses the independent and private sectors. One organisation, Take Care, provides a superb
level of care. The social services department does not take a dogmatic attitude, but there is a distinct lack of resources. The department cannot use the private and voluntary sectors more, because of Government underfunding.
Bed blocking is only one aspect of the crisis facing our areas. Robert Tinston went on to say:
The hon. Member for Chipping Barnet should beware. If the rationalisation that took place at Broadgreen takes place in his constituency, his constituents will face the same lengthy waits in undignified and cluttered surroundings as my constituents have at the Royal hospital.
Dr. Tinston made suggestions in his report, some of which would certainly help. He concluded:
Conservative Members claim to be spending more and more money year on year on the NHS, but such spending must be balanced against the constant reduction in funding of social services and community care through local authorities: one impacts on the other. It is the same old situation. The Government are taking from local authorities to spend on the NHS. Hospitals are not able to discharge patients into community care because of underfunding of social services. Patients are therefore staying in hospital while others are having to wait to be admitted because they cannot get a bed.
Mr. Burns:
I am grateful to the hon. Gentleman for giving way. [Laughter.] Sorry, the hon. Lady. I do her a disservice. The hon. Lady seems to be suggesting that the Government have cut funding for community care. Nothing could be further from the truth. Money for community care has been increased year after year after year, like health service funding, so that, at the moment, it totals just under £6 billion a year.
Mrs. Kennedy:
I am very interested in what the Minister has to say, but I must point out that that community care funding has to deal not only with an aging population but with patients coming out of mental institutions. I shall not go into the problems that we have seen in that area. Resources, particularly those relating to local authorities, are inadequate and have been cut. The Minister is referring to funding as it applies to the health service, but I am talking about funding coming through local government.
Mr. Burns:
No, I am talking about money going to local authorities.
Mrs. Kennedy:
I listen to what the Minister says. I will take that on board and look at it. If he is right, I shall come
I turn to the subject of waiting lists, which is of particular interest to me. A calender of events was issued to directors of the Royal Liverpool and Broadgreen University Hospitals NHS trust in the last week of January. The national diary flagged up that it was expected that NHS waiting list statistics for England--resident based--for 1995-96 would be published on 3 February.
I received a copy of a memo from which my hon. Friend the Member for Islington, South and Finsbury has already quoted. I want to take the House back to it, because I believe that it gives the game away. My hon. Friend wrote to the Secretary of State enclosing a copy of the memo, and on 2 February The Independent on Sunday quoted not only the memo but other NHS trusts across England that had experienced similar, shall we say, manipulation of the figures.
The memo, which was compiled by the contracts and information department of the Royal trust, says:
I telephoned a number of trusts around the region and asked them about the average time they would ask the patient to wait having been given a date to come in--how long in advance were patients given. The average time was two weeks. We know that one of the trusts in Coventry was able last year to announce to a fanfare that it had reduced waiting lists to less than nine months, yet, on examination, it was discovered that it had simply issued a date to come in for all its patients who had waited for more than nine months and therefore removed them from the waiting list. That is a sleight of hand, a dishonesty, a distortion of the picture and one of the reasons why people have lost their confidence--if they ever had any--in the way in which the Conservative party manages the health service.
The memo goes on to say:
The memo is very honest. It goes on to say:
I asked the Secretary of State to confirm whether the figure of 299 waiters declared by the Royal was inclusive of all those waiting for treatment in the orthopaedic, ear nose and throat and ophthalmic specialities to which I referred. He did not answer me. He said that the figures were intended to be a proper statement of the facts. Since recent figures have been published, consultants have complained to Members of Parliament and contested the figures.
The facts have been doctored, manipulated, massaged, amputated--the list of medical metaphors continues. In the words of the memo, there is no doubt that the figures have been subject to "judicious elimination". That calls into question the entire basis of the Government's case.
I echo the call of the member of staff to whom I referred for an inquiry into what has been going on at the Royal Liverpool university hospital, and especially the accident and emergency department. That could be conducted under the aegis of the community health councillors, who are highly regarded locally.
When I visited the cardiothoracic centre in Liverpool, another truth about waiting lists came out. Medical staff are required by the Government's rules to offer treatment to patients based not on clinical need but on who is at the top of the most pressing waiting list, and GP fundholders' patients take priority over other patients.
A great defence has been made of GP fundholding, but because GP fundholders' patients take precedence, the other patients have to wait unacceptably long for treatment. I therefore warmly welcome our proposals to restore GP services by the extension of commissioning. A commissioning pilot in my constituency has been strongly supported by the participating GPs.
The Secretary of State quoted Aneurin Bevan as saying that GPs were to be the gateholders to NHS services. The chair of the local medical committee in Liverpool, Dr. Rob Barnet, said to me that, if we were not careful, hospital services in the future would be on the basis of emergency admission only and that elective work would increasingly be required to be carried out by the private sector.
Real people are affected by the matters that we have been debating. I refer to the case of Mr. James Hartless, who first came to me when he was 73, two years ago. He has been a patient of the cardiothoracic centre in Liverpool for 10 years. He went into the accident and emergency department at the Royal on 18 April 1996. A letter of apology from the department said:
In a letter of 20 September, Mrs. Hartless said:
"As hospitals have closed, they have been replaced with new facilities which recognise modern clinical advances . . . It is becoming increasingly clear that we have removed the bed stock capacity that used to cope with peaks of demand. We see this when we look at towns where rationalisation is yet to take place. They appear to cope for longer."
He was talking about coping with what is described in the health service press release as
"an unprecedented increased number of patients who are presenting for admission"
with problems that were quite unexpected.
"I can give no absolute guarantee that, should pressures be as bad, or worse, than last year, that we would have radical, new and innovative measures in place to deal with them. These take some time to implement."
As I have already said, the BBC report said that this year has been as bad as, if not worse than, last year.
"The Trust declared 12-month-plus waiters at the end of the second quarter of 1996-97",
which would have been in September. It continues:
"The figures showed an accurate picture for Urology and for General Surgery . . . in the 12m, 13m and 14m categories"--
only for patients of Liverpool health authority--
"and of other Health Authorities in the 12m category."
But not all patients were declared. The memo says:
"Patients showing in the following categories were not declared in line with the regional request to keep figures as low as possible".
Patients waiting longer than 12 months in the categories of orthopaedic, ophthalmology and ear, nose and throat specialties were not declared anywhere. Patients who had been given a date to go into hospital for treatment were also not declared.
"The Region have indicated that the figure of 329 declared by the trust in November is very high and have suggested"--
as my hon. Friend the Member for Islington, South and Finsbury quoted--
"a judicial elimination of the TCI patients."
There can be no interpretation other than that the regional NHS executive was insisting that the managers of the Royal reduced the number on the waiting list simply by the sleight of hand of giving people a date on which to go into hospital.
"This elimination of patients with a TCI date is causing problems due to the frequent cancellation of elective work as a result of the bed situation . . . If the Trust accede to Region's request at this point it will face a greater problem in the future as the true position is likely to worsen substantially."
The figures were not published on 3 February--surprisingly. They were published last week. What do we find? Provider units in the North West region have more patients waiting than any other region, and the latest quarter saw a rise of 4,280. That represents more than 25 per cent. of the national increase in that category and was the highest proportionate increase of all regions.
"it is entirely unacceptable that Mr Hartless arrived in the department at 09.30 hours, to be seen and assessed by the Accident and Emergency Senior House Officer within thirty minutes, and then
24 Feb 1997 : Column 84to wait until almost 18.00 hours before being admitted to a ward. On the day in question, the Accident and Emergency Department was extremely busy. On this day the department was so full that every cubicle and trolley space in the Resuscitation Room and on Majors was blocked, and every bed in the Observation Ward and the overflow area was full, and patients were waiting on trolleys in the corridor."
That was not an isolated incident in the middle of winter, with beds blocked by patients with pneumonia: it was in April. The same patient presented at the A and E on three separate occasions in the run-up to July and waited for a combined period of 18 hours for bed space and treatment.
"We waited 3½ hours for the Doctor to come back to us to tell us the results. This poor Doctor was away somewhere else, that busy, thus resulting in these long hours on a trolley. This is not a complaint but . . . morale is so low that it has to be seen . . . So this is the year of 1996, and I fear for the future.
Would that Conservative Members thought the same. If patient care is paramount, it is not acceptable for them to dismiss the experiences of patients such as my constituent as mere scaremongering or bitching. That is not the case. We are talking about real people who have experienced real problems with the health service, and it is to Conservative Members' discredit that they dismiss them out of hand.
Sorry about this moan, but I thought I would let you know. Here we take each day as it comes, anxiety is at its peak, but most of all it is my husband's care that is paramount."
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