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Fuel Poverty
3. Mr. Alan Simpson (Nottingham, South): What suggestions he has received about the role of primary care groups in addressing the health consequences of fuel poverty. [72377]
The Minister for Public Health (Ms Tessa Jowell): One of the three key tasks for primary care groups will be the improvement of the health of their local population, and we attach great importance to that role. Fuel poverty can contribute to increased risk of heart attack, stroke and respiratory conditions such as flu, pneumonia and bronchitis. An interdepartmental group reviewing all Government policy on fuel poverty identified primary care groups as a potential way of reaching households in need of help with that problem. Work is in hand to explore that possibility further.
Mr. Simpson: Will the Minister ask the interdepartmental group to pay particular attention to work being done on warm homes programmes in at least two areas? First, in Cornwall, considerable work is being done to tackle child asthma and, secondly, in Birmingham, a collaboration with the local authority allowed home insulation to be offered on prescription. Will my right hon. Friend consider the lessons to be learned from such initiatives and seek to extend them where possible so that we can ask primary care groups to tackle the causes of ill health as well as its consequences and costs?
Ms Jowell: I am delighted to take on board my hon. Friend's suggestions for good practice and to reaffirm the Government's commitment to tackle the root causes of ill health by working across Government and, in doing so, to tackle inequality in health, which blights our society.
Mr. Archie Norman (Tunbridge Wells): Is the Secretary of State aware that the right hon. Member for
Darlington (Mr. Milburn), when he was a Health Minister and before he became Chief Secretary to the Treasury, reassured Conservative Members that there would shortly be an announcement on the next round of hospital private finance initiatives, including the consideration of a case in my constituency relating to West Kent and East Sussex--
Madam Speaker: Order. I think that I must have called the hon. Gentleman on the wrong question. This question concerns the health consequences of fuel poverty. I call the right hon. Member for Bromley and Chislehurst (Mr. Forth).
Mr. Eric Forth (Bromley and Chislehurst): What is fuel poverty compared with, for example, food poverty or clothing poverty?
Ms Jowell: Fuel poverty is measured as the need to spend over 10 per cent. of one's weekly income on keeping warm.
Mr. David Kidney (Stafford): The question demonstrates one of the many demands on the boards of the new primary care groups at this stage. If the Stafford primary care group is anything to go by, the management structures are certainly as lean as the Government would like them to be. Will the Minister assure the House that the new boards will have adequate resources and training so that they have the expertise as well as the time, which is very important, to be able to deal with conflicting demands at this important time in their establishment?
Ms Jowell: We are determined that the role of primary care groups will not be only to deliver primary care to local people, but to act as a major force in meeting the Government's targets for broader health improvement and reducing preventable deaths. We shall certainly work with primary care groups so that they are clear not only that they are in the business of ensuring that people receive treatment for ill health, but that they are a force for health improvement.
Dr. Peter Brand (Isle of Wight): I am sure that the Minister recognises the importance of delivering the wider public health agenda and the role of primary care groups in that aim. Does she agree that local authority services are an integral part of the delivery of the wider public health agenda? Would not it be sensible to integrate, perhaps as pilot studies, a number of health and local authority services so that we can find out whether the proposals can go further? A coterminous area such as my own, an island, would welcome such an initiative.
Ms Jowell: We certainly recognise the importance of close partnership between health and local authorities in tackling health inequality and improving health. The hon. Gentleman will be aware of the many steps that the Government have taken to reduce the obstructive and artificial boundaries between health and local authorities. The Health Bill will set out a new framework, including a duty of partnership between health and local authorities, so that the people of a given area no longer have to grapple with the dreadful bureaucracy that results from a single need being met sometimes by services from the local authority, and sometimes by health authority
services. Health improvement is also about making sure that we achieve closer integration of the working of health and local authorities.Hospital Trusts
4. Mr. David Ruffley (Bury St. Edmunds): What representations he has received regarding levels of funding for NHS hospital trusts. [72378]
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): The Department, through the NHS Executive and its regional offices, is in day-to-day contact with NHS trusts and health authorities in their role of managing the national health service. Representations are made during those contacts, including by Members of Parliament, through formal channels such as parliamentary questions.
Mr. Ruffley: Is the Minister aware that many of my constituents who use the West Suffolk Hospitals NHS trust believe that the Government's funding policy discriminates against trusts in rural areas, such as their's, compared with urban areas? In that respect, may I draw the Minister's attention to today's report of an inquiry into the East Anglian Ambulance NHS trust, the performance of which is giving rise to great concern among many people in Suffolk? I am aware that the Secretary of State has taken a personal interest in the report. Given that meeting the goals in that document relies on increased funding, will the Minister give an undertaking to welcome a delegation of Suffolk Members of Parliament so that they may lobby for fairer health funding for Suffolk?
Mr. Hutton: I shall say two things to the hon. Gentleman. First, we will not accept any lectures from him and his hon. Friends about national health service funding. His tirade completely omitted any reference either to the 5.5 per cent. cash increase in Suffolk health authority's funding, or to next year's real-terms increase of more than £11 million for Suffolk health authority. I am rather surprised that he managed to let those figures slip through his fingers.
Secondly, the hon. Gentleman may not be aware of it, but we have already made an adjustment to the funding formula to allow additional resources to be made available to rural ambulance services.
Mrs. Anne Campbell (Cambridge):
Will my hon. Friend ensure that the very generous funding allocated to the NHS by this Government is spent wisely? Will he look at the report into the East Anglian Ambulance NHS trust, which points to deep-seated management problems, many of which I have been drawing attention to for many years? I hope that he agrees that we should concentrate on the way in which such resources are spent.
Mr. Hutton:
I am grateful to my hon. Friend and I very strongly agree with what she says. It might help the debate and the clarity of the issues if Conservative Members were prepared to address the reality rather than criticise the Government's record on funding. In 1996-97, the total of NHS trust and health authority deficits was nearly £460 million. By the last quarter of 1998-99, we had managed to reduce that to £80 million. That is the bottom line.
Mr. Philip Hammond (Runnymede and Weybridge):
Will the hon. Gentleman confirm that most NHS acute
Mr. Hutton:
No, I do not accept that criticism--any part of it, or any word of it. If the hon. Gentleman were able to look at the performance of the NHS over the past few months, especially over the difficult winter period, I am sure that he would join me in congratulating the staff on their excellent work. He may well want to consider the very interesting figures on the reduction in waiting lists.
5. Mr. Phil Sawford (Kettering):
How many accident and emergency departments will receive funds for improvements this year; and if he will make a statement. [72379]
The Secretary of State for Health (Mr. Frank Dobson):
Seventy-nine accident and emergency departments in all parts of the country will be upgraded in the coming year with money from the NHS modernisation fund. That is a third of all A and E departments in England. It will mean better and quicker services for patients, and better and safer working conditions for staff. That extra investment from the modernisation fund augments the upgrading that is already being funded as part of the general increase in capital for the NHS which this Government have introduced.
Mr. Sawford:
I thank my right hon. Friend for that answer and welcome his massive investment of funds in our national health service. However, is he aware that many NHS trusts, including Kettering general hospital in my constituency, have already modernised their accident and emergency units and fear that, as a result, they may lose out on Government funding? Is it his intention that all future modernisation funding will be earmarked for specific purposes, or will there be some discretionary funding for local projects identified as meeting local needs?
Mr. Dobson:
The straight answer is that there will be a mixture. Some of the extra capital funds will be entirely at the discretion of the local trust; some of the money that comes from the ordinary allocation of funds will have some priorities given to it by me; and some of it, from the modernisation fund, will be specifically laid down from the centre.
We believe that it was right and proper, for instance, to try to bring all accident and emergency departments up to the standard that prevails in Kettering, because we believe that a good standard should apply everywhere. When that has been done, additional funds will go elsewhere.
However, I have said that the national health service management, with the extra capital that it is getting this year, must give priority to replacing unreliable equipment that goes on the blink and breaks down. That is very bad for patients. One of the most frustrating aspects of
working in the national health service is to have to work with the clapped-out old equipment on which the previous Government spent no money over the past 19 years.
Mr. Simon Hughes (Southwark, North and Bermondsey):
When will there be enough money for our accident and emergency and other hospital departments to ensure--and to employ the necessary staff--that we reduce the number of people who have seen their consultants and are waiting to get into hospital to below the level that the Government inherited; to reduce the number of those waiting to see their consultants--which is 200,000 more than when the Government came to office--below the number that they inherited; and to ensure that our A and E departments treat the recommended number of 100,000 a year, not 150,000 a year, which is the number of people expected to go through the doors of St. Thomas's hospital when Guy's hospital closes later this year, thanks to the right hon. Gentleman's decision?
Mr. Dobson:
Just in case the hon. Gentleman causes any more Liberal hairs to rise, Guy's hospital is not going to close. The A and E department will close because, in the opinion of the people whom we have consulted--who know more about accidents and emergencies than even the Liberal party--the alternative arrangements that we are making, as recommended by Sir Leslie Turnberg in his report, will be satisfactory. However, as the hon. Gentleman knows, and should have said if he is prepared to be straightforward about this matter, I have said that we shall keep a very close eye on that.
We must recruit more staff, and we are doing so; we must improve equipment; we must make layouts safer; and we must install closed circuit television to stop the yobbos beating up nurses. Indeed, we are doing all those things, but the management must also improve in many places.
We have insisted on getting admissions wards into every district general hospital. When we took over, almost half the district general hospitals in this country had no admissions ward to back up the accident and emergency department; now, only 20 do not have one.
Mr. Dennis Turner (Wolverhampton, South-East):
As my right hon. Friend knows, one beneficiary of the improvement programme is New Cross hospital in Wolverhampton. At the cost of making him blush, may I tell him that the improvements to and upgrading of our A and E department and the provision of an extra 22 beds are most welcome? Can he confirm that that is further evidence that Labour is keeping its promises? I say on behalf of Wolverhampton, thank you very much.
Mr. Dobson:
My hon. Friend, with his mastery of understatement, only repeats what many doctors and nurses told me in his presence last time I was in Wolverhampton.
One thing that we are doing with the extra money for modernising A and E departments is to put an extra £600,000 into modernising that department at Whipps Cross hospital in east London, and we shall sort out its management as well. That hospital needs a better A and
E department, and it needs to be better run than it is at present if we are to avoid the scandalous things that happened there this winter.
Mr. Gerald Howarth (Aldershot):
Is the Secretary of State aware that, when the Prime Minister was grinning on the steps of Basingstoke hospital while announcing the proposed investment in A and E facilities, one of my constituents, just 20 miles down the road at Yateley in Hampshire, was suffering from a lack of Government funding? That constituent had an operation in 1995 at a specialist London hospital outside his area, followed by three check-ups, but has now been denied a further appointment there. He has been told by the local health authority that, in common with many others, it is experiencing severe financial difficulties. It states:
Is not the truth that the Secretary of State castigated the Conservatives when he was sitting on the Opposition Benches, but has failed to deliver patient care in government?
Mr. Dobson:
If the hon. Gentleman sends me the details of that case, I shall look into it. From bitter experience at the Dispatch Box since I have had this job, I do not give full credence to what Tory Members read out. However, what he says may be correct.
When my right hon. Friend the Prime Minister was mobbed by delighted hospital staff, he was at Basingstoke hospital to mark the effort to bring its A and E department at Basingstoke up to the sort of level that we need for the next century, including the introduction of an X-ray machine specifically for that department, which will be better for the patients and speed up the process altogether. I should have thought that the hon. Gentleman might just have welcomed that, but of course he cannot really welcome it without a touch of hypocrisy because the shadow Chancellor says that we are spending too much on the health service.
Audrey Wise (Preston):
In welcoming the announcement, may I draw my right hon. Friend's attention to the fact that although many A and E patients are children, many A and E departments make no special provision for them? Will my right hon. Friend check on the position of the 79 A and E departments and ensure that the modest changes that are necessary properly to receive and reassure children are put in place as part of the upgrading?
Mr. Dobson:
That is certainly the case; my hon. Friend makes a valuable point. It would be wholly reasonable for me to add that one of the changes in Basingstoke is to provide a specific area for children in the A and E department, just as the £882,000 that we are giving to the Central Manchester trust will create separate children's A and E areas in the central Manchester hospitals.
Rev. Martin Smyth (Belfast, South):
The Secretary of State will be aware that many A and E departments are used as drop-in centres, preventing the staff from doing
Mr. Dobson:
As the hon. Gentleman knows, there is almost a theological dispute among trauma experts about whether we should have trauma centres or A and E departments as we have at present, and some places are moving more towards trauma departments than others. I have some sympathy with people who use their local A and E departments as a drop-in centre if they are feeling off colour. That has certainly been a characteristic of the major inner-city teaching hospitals of all our great cities.
"We are desperately trying to ensure that we continue to provide the best quality care for all our residents but, regrettably, do not have the financial resources to allow for freedom of choice for individuals."
It went on to say that, unless more taxpayers' money was made available, it would not be able to deliver the service.
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