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Mrs. Beckett: My hon. Friend makes a powerful point. There is an important balance to be struck in preserving the rights of Back Benchers on both sides of the House. We are in danger of straying into territory in which the freedoms that are properly, sensibly and rightly available to Members are used to create problems that will ultimately be resolved. Every Government have had to make such decisions from time to time. If we face continual tactics of the kind that we saw in the discussions of the Representation of the People Bill, such matters will have to be considered.
Mr. John Bercow (Buckingham): As an assiduous attender of debates in the Chamber, may I assure the right hon. Lady that Conservative Members simply sought to amend ill-considered, confused and sometimes downright stupid features of the Representation of the People Bill? Her statement, which attempts to prevent us from continuing to do that, is an abrogation of the democratic rights of the House.
Will the right hon. Lady also note that the hon. Members for Corby (Mr. Hope), for Reading, West (Mr. Salter) and for Ellesmere Port and Neston (Mr. Miller) all had one characteristic in common when they pronounced judgment on Conservative Members? None of them was in the Chamber for the debates this afternoon or this evening.
Mrs. Beckett:
The hon. Gentleman should bear in mind--I notice it continually--that, although Members may not be present in the Chamber, they observe our debates.
Mr. Michael Fabricant (Lichfield):
On television.
Mrs. Beckett:
The hon. Gentleman says, "On television" as though there were something shocking about that. Nevertheless, those Members hear our debates. It is not valid to assume that Members who have not been present in the Chamber are not aware of the debates.
I recognise that the hon. Member for Buckingham (Mr. Bercow) is an assiduous attender in the Chamber and takes part assiduously in our business. On the whole--I do not wish to do him any harm--he is not among those who are most guilty of sometimes using our procedures in the way to which I have had to draw attention tonight. Although it may not suit Conservative Members to admit it, he will be as well aware as anyone else that it is important to strike a balance. On the one hand, we should preserve the proper freedoms of Members and, on the other, we should deal properly with the business--Government or otherwise--that is before us. If that balance goes adrift, it has somehow to be remedied.
Mr. Hope:
On a point of order, Mr. Deputy Speaker. The hon. Member for Buckingham (Mr. Bercow), in his
Mr. Deputy Speaker:
Order. The hon. Gentleman must sit down if I rise to my feet--[Interruption.] He must not try to continue the debate from a sedentary position, otherwise he will get into real trouble. He raises a point for debate, which he will have other opportunities to raise if he wishes. It was not a point of order for the Chair. We have heard quite sufficient on the matter tonight; there will be a debate tomorrow.
Mr. Wilshire:
Further to that point of order, Mr. Deputy Speaker. During the questions to the Leader of the House on her statement, a Labour Member used the word "filibuster" to describe contributions that you and other Deputy Speakers have clearly ruled are perfectly proper and in order. Is it in order to use the word "filibuster" in those circumstances?
Mr. Deputy Speaker:
Great emotion normally arises when timetable motions are introduced. The proceedings have been chaired throughout the evening in such a way that we have noticed when an hon. Member has been out of order, and that has been dealt with. For the most part, as we know, proceedings in the House move slowly; at other times, they move amazingly quickly. Generally speaking, everything has been in order this evening.
Ordered,
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Dowd.]
Mr. Deputy Speaker:
Before I call the hon. Member for Northavon (Mr. Webb), I ask those right hon. and hon. Members who are not staying for the Adjournment debate to depart quickly and quietly.
Mr. Steve Webb (Northavon):
I am grateful for the opportunity to raise in the House tonight the situation in the national health service in the Avon area, which is of grave concern to myself and my constituents. The matter is of particular note at the moment because of winter pressures.
May I say at the outset that I want to place on public record my appreciation and tribute to the NHS staff in the Avon area, who have performed remarkable feats in recent weeks. There can be no doubt that it is their dedication, devotion and hard work, which is well beyond the call of duty, that has enabled the health service in my area to keep going under extraordinary pressures.
The chairman of the North Bristol NHS trust, which serves my constituents, said in a letter to all hon. Members in the Avon area:
It is because of the appreciation of the work that NHS staff are doing that it is particularly important that they are not taken advantage of. My concern is that the NHS is relying too much on the good will and hard work of its staff, and it may even be taking advantage of their good will. In many respects, the NHS is close to breaking point, not only this winter but at other times, and it is only the staff's dedication that prevents things from going seriously wrong.
I want to set out the background to what has been happening in Avon, to look back at events of recent weeks and to consider whether those might have been prevented or dealt with better. I want also to consider the health authority's future and the pressures that it faces. I am grateful to the health authority, to North Bristol NHS trust and to the chairman of my local primary care group for briefing me in advance of this debate.
We have been through a remarkable few weeks. In the two weeks after Christmas, emergency admissions in the Avon area were 14 per cent. above the levels in the preceding autumn, which were themselves relatively high. That is an average over the whole authority. In the North Bristol NHS trust, which serves my constituency, there were
How did the service cope? As far as we can tell, it coped remarkably well in the circumstances. The briefings from the health authority and the trust suggest that the planning for the general run of winter pressures, coupled with the good will and endeavours of the staff, meant that many of the worst possible outcomes did not materialise.
Having said that, things were extremely difficult--in my view, unacceptably so. To humanise the problem, I quote not the health authority statistics--valid though they are--but the letter dated 12 January from the chairman of the North Bristol NHS trust to Members of Parliament. She writes that the pressure began on 3 January,
The chairman goes on, making a critical point:
It shows the strain under which the health service was operating that, for six hours, Frenchay and other hospitals were effectively closed. It worries me that the trusts are running so close to capacity. Even though I acknowledge that there was a seasonal peak in demand--I do not want to argue about whether it was an epidemic--it was not beyond the bounds of possibility that such an event would occur. Hospitals had to close because we run the health service so close to capacity. I am worried that we reached the point where, despite the best efforts of staff, there was only one neurosurgical bed in the whole of southern England and Wales, and hospitals were effectively closed for six hours.
At this point, I should like to put in a plug for my local cottage hospital in Thornbury. The chairman of my local primary care group has pointed out that, without Thornbury hospital, there would have been
Could those events have been foreseen or prevented? Management plans were in place, but was there enough preventive work? Was there a sufficiently energetic
inoculation programme in the autumn? My impression is that there was some effort, but not enough. Will more effort be made next year, or will we run the risk of the same thing happening again? Is the NHS running too close to capacity? My feeling is that the financial pressures being put on the health service mean that it is, with the result that when circumstances such as a severe flu outbreak arise, its facilities are stretched close to breaking point.
We must look forward and ask what will be the legacy of those winter pressures during the coming weeks and months. It is obvious that there will be pressure on waiting lists. The letter from the chairman of the North Bristol NHS trust states:
The trusts face two substantial pressures, the first of which is the additional costs that they have incurred in dealing with flu and the winter crisis. Will the Government meet these costs or will the money have to be found from the trusts' budgets? The money was not budgeted for, so will that mean cuts in other NHS services?
The chairman's letter from which I have been quoting concludes:
The second funding pressure that I fear they will face is from the pay award announced this week. I understand-- I hope that the Minister will correct me if I am wrong--that the money that has been promised to nurses and others, which is entirely welcome, must be found within existing NHS planned and present budgets. In other words, there is no new money to match the new pay award. If the trusts are finding money to cope with the winter pressures that they did not have in the budget and if next year they have to find money for salaries that was not in the budget, what will be cut? If the Government will not meet these shortfalls, what will the trusts have to cut?
I shall look ahead and set out what might happen if the winter pressures, and the financial pressures that have followed from them, are not dealt with. I received an e-mail from a constituent--to preserve her confidentiality, I shall call her Mrs. A--who e-mailed me within minutes of seeing the news about the lady from the north of England who had cancer treatment repeatedly postponed.
The story has appeared in the media. Mrs. A tells a heart-rending tale of the state of the NHS and of the problems that will not be dealt with if the trusts do not have the necessary money. She states:
The Government have a chance to do more than what the Prime Minister promised, which was to reach an acceptable funding level in five years' time. They could start this April. They could go beyond their published spending plans and not cut the standard rate of income tax by 1p in the pound. That would raise well over £2 billion, which our health service needs now. The Government seem to be saying that it will take years to find the necessary money, yet they are handing over £2 billion to taxpayers who, all the evidence suggests, want that money to be spent on the health service that they and we treasure.
That Jane Kennedy be discharged from the Administration Committee and Mr. Mike Hall be added to the Committee.-- [Mr. Keith Bradley, on behalf of the Committee of Selection.]
19 Jan 2000 : Column 946
10.26 pm
"Our nurses and physicians are working more than flat out and our surgeons are assisting them."
Clearly, the staff in the NHS deserve our warmest thanks and appreciation, which all too often they do not receive.
"some days when emergency admissions increased by 40 per cent."
Those are extraordinary pressures for the health service to bear.
"when people, suffering from the complications of flu, started to pour in . . . We have no doubt that the people who are being admitted need to be in hospital--they are very ill."
There is no question that the admissions were not necessary. She says that on 7 January, the pressures were "particularly bad".
"In Frenchay Hospital"--
which is in my constituency--
"we even had to turn our day surgery units into holding bays for the medical patients we were admitting and cancel all day cases."
By midday that day, out of the 654 beds in the hospital, only one was available. It had to be kept available because, by that point, Frenchay was acting as a receiving centre for neurosurgery, not just for Greater Bristol or for Avon, but for the whole of the south of England and the whole of Wales. Perhaps we should be having debates about the circumstances in which health services everywhere but Avon found themselves, given that our local hospitals were under such pressure, having to serve such a huge area. I am greatly concerned about the time it would have taken for someone from the far south of England or a remote part of Wales to reach Frenchay.
"At this point we did something which we never had to do before. We made an arrangement with United Bristol Healthcare Trust and Royal United Hospital NHS Trust."
They agreed that each hospital would, in turn, for a three-hour period, take in all further admissions in the area, except for "blue light" cases or those who turned up at casualty. That gave each hospital six hours to catch its breath and get things under control.
"significant extra pressure on Southmead/Frenchay."
Thornbury has 24 beds, but only one of them was free and there was rapid turnover during the Christmas and new year period. Cottage hospitals have recently come under threat; I urge the Government, when considering their future, to bear in mind the important role that they play, especially at busy times.
"I know you will appreciate that, with this pressure on our services, we are not able to keep up with the planned reduction of our waiting list. We are now falling back by about 40 operations a day. If and when the emergency demands reduce, we will do our best to catch up . . . but our staff will be very tired and we must not push them beyond the limits of safety."
Over the Christmas and millennium eve period, many staff put in extra time that they would not normally have put in, and they expected a new year break in return. That has not materialised and it is not clear how the waiting list backlog can be cleared without substantial support from central Government.
"My Board has spelt out clear priorities for the Trust; firstly, to treat emergencies; secondly, to meet the in-patient waiting list targets and thirdly to meet financial targets."
In my view, that is the right sequence--patients first and money second. However, in the modern NHS the trusts are businesses. If the Government do not help them with the additional financial pressure that they face as a result of the winter crisis, how will they cope? How will they reduce waiting lists? How will they improve NHS services and not merely stand still?
"We are prompted to write after hearing about the cancer patient . . . My husband has been fighting cancer for 17 months now and has first hand experience of the desperation waiting lists can cause. He had to wait six weeks for radiotherapy that his consultant really wanted him to have immediately after an intense course of chemotherapy. He has since been told he is terminally ill and we can't help but wonder what difference that waiting time would have. We are disgusted that the national health service has been allowed to be grossly underfunded when, as we have learnt, health is all that matters and that without your health you have nothing. We beg of you to hound government ministers responsible to stop looking at short term voting gains and put the income tax up and the money where it is needed."
The final line of her e-mail reads:
"By the way, my husband is . . . 32 years old and will leave three children fatherless."
I naturally responded promptly to that communication, and I received a further message from Mrs. A, which re-emphasised the pain that she has felt and her distress about the health service. I shall read part of her message to me. She states:
"On the day my husband was asked if he wanted to give one last, new treatment a go (or else have six months to live) the nurses on the ward were using up 'favours' between the departments to get him a C.T. scan. They could only wrangle an X-ray!! This obviously is just a split moment in our lives that caused desperation on top of desperation. The nurses, no wonder, probably feel such desperation daily, again because of what boils down to lack of funds. What would a penny on Tax be to everyone and how many lives and families could that keep going?"
When Liberal Democrat Members say that more should be spent on the NHS, we are sometimes asked where it should come from. I make no apology for the fact that I have called for extra spending on the NHS. I have called for the trusts to be reimbursed for the costs of the winter pressures, which were unforeseen. I have also called for the Government to meet the costs of the pay rise that were not budgeted for. Above all, when situations arise that affect people such as Mrs. A and her husband, I cannot believe that the NHS is properly funded all year round, let alone during the winter.
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