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Dr. Peter Brand (Isle of Wight): Does not the hon. Gentleman recognise, as I do as someone who has worked in the NHS for the last 20 years, that in such cases NHS servants are only exercising the skills that they have honed over the last two decades?
Dr. Fox: We are discussing what, according to huge numbers of people who work in the service, has increasingly become a culture of fear, bullying, intimidation and the suppression of truth and of the interests of individuals. It is increasingly likely that managers of trusts and health authorities will be phoned by Ministers or senior civil servants and be given a dressing down and asked why they are not giving core good news stories to the newspapers instead of allowing bad news about what is happening in the NHS to filter out. In running our health service, the Government's culture is becoming increasingly corrupt, and the NHS is playing second fiddle to the interests of the Labour party's news machine.
At last year's Labour party conference in Bournemouth, Victoria MacDonald, the health correspondent for "Channel 4 News", was confronted by Joe McCrea--at that time the special adviser to the Health Secretary--who unleashed a stream of abuse at her, at one point throwing a mobile phone. I shall not repeat his language because it would not be suitable for Hansard. Victoria MacDonald explained the reason for the attack to the British Medical Journal, saying that Mr. McCrea thought that she was off-message because of a film that she had made about the waiting lists initiative.
In the film, which was made as a result of several off-the-record briefings, Victoria MacDonald suggested that the then Health Secretary was keen to ditch the waiting list initiative because it was distorting priorities. She said that he did not like the word "ditch" because he thought that it was damaging to the Government, although he did say that Ministers had come round to the idea that waiting times were more important than waiting list numbers. She wanted to report what Ministers genuinely thought, while they wanted to maintain complete control because they thought that in the short term the spin would be wrong for the Government, even though the policy may be right. How twisted and perverse is it possible to be? [Hon. Members: "You should know."] Labour Members may think that it is funny that professionals who work in the media or the NHS should be subjected to a culture of bullying, fear and intimidation. They may think that that is immaterial and that sitting on the Government Benches is more important than any respect for truth or for professionals. However, those outside the Chamber certainly will not think that, and they will note the attitude of Labour Members.
Another major priority for the Labour Government when they came to office was their desire to abolish the internal market and to reorganise the system. The current Secretary of State takes great credit for having abolished the internal market, but Lord Winston, in the other place, says that one of the Government's biggest failings is that they have not abolished the internal market. It is difficult to know who is in touch with reality. However, the effect on the system of Labour's ideological reorganisation matters more than the question of who is giving us the correct version--and, as ever, the effect is that we get less choice.
Just this week, 24 of the United Kingdom's leading neurosurgeons, neurologists and anaesthetists joined the Parkinson's Disease Society in calling for changes to the current mechanism. They explained:
- Since the abolition of Extra Contractual Referrals in 1999 many patients with conditions such as movement disorders, spinal injuries and severe chronic pain syndromes are no longer able to benefit from treatment outside their local area. The current funding arrangement, known as Out of Area Treatment Allocations . . . operates under a fixed annual budget regardless of demand for operations. No mechanism now exists for the transfer of funds from Local Health Authorities to specialist centres.
- We are told that since the abolition of ECRs no mechanism exists for the transfer of funds to follow the patients that urgently need our help. Consequently our waiting lists continue to grow and we are
- unable to treat these patients with the procedures they need. We have gone backwards since last year and the year before. This is unacceptable.
Dr. Fox: I shall give way to the hon. Gentleman if he thinks that that is acceptable.
Dr. Palmer: As the hon. Gentleman continues his review of the media, would he like to comment on the today's admirable editorial in The Daily Telegraph, headlined "Dr. Fox's good health", which examines his proposals in detail and states:
- Those who continue to rely on the NHS for their health needs should not expect an analogous level of care.
Dr. Fox: I accept that that is the view of The Daily Telegraph editorial today. I shall deal with my views shortly. [Interruption.] Given that we are discussing the lack of treatment for people with Parkinson's disease, and the fact that neurosurgeons and neurologists cannot refer their patients for the treatment that they want when they say that they were able to do so only a short time ago, it is interesting that the hon. Gentleman puts the interests of the Whips Office before those of patients in the NHS.
Dr. Fox: I have given way several times already, and I shall do so again later.
Another priority in the Government's armoury is to make funding available for their pet proposals. We have had reports this week that hospital managers say that the Government's national changeover plan in preparation for Britain's entry to the European single currency is costing millions of pounds and increasing work loads dramatically. A trust manager said:
- The plans will require substantial extra work from staff at a time when we are facing disintegration through the loss of mental health services, community hospitals and community services.
- computers, printers, financial forms and stationery will be changed and new equipment for cashiers, vending machines and car parks required.
- It is likely that management consultants may be needed to support the process.
We received information this morning suggesting, from calculations made throughout the country, that the cost of preparing for the Government's changeover plan could be between £75 million and £95 million for this year alone in the NHS. Will the Secretary of State tell us whether those figures are accurate, too low or too high?
Dr. Howard Stoate (Dartford): Will the hon. Gentleman give way?
Dr. Fox: If the hon. Gentleman--he has practised as a doctor, so I shall give way to him--thinks that spending
£75 million to £95 million on preparing for the euro is a good use of NHS money, I look forward to hearing from him.
Dr. Stoate: The hon. Gentleman will know, as a doctor, that GPs find it impossible to refer out of area because the Government of which he was a member set up extra-contractual referrals in the first place to limit GPs' freedom to refer out of area. If he thinks that the ECR system delivered the goods, I am afraid that he needs to talk to some more GPs, because the GPs know that the ECR budget was so tight that it was almost impossible to get health authorities to agree to pay for ECRs in the first place.
Dr. Fox: Sometimes I really do despair. If the problem with extra-contractual referrals was that the budgetary constraints were too tight, the solution would have been to loosen them, not to abolish the system. That is typical of all that the Labour Government want to do; they want to level down to the lowest common denominator and deny choice to doctors and patients, which is exactly what they have done. The consultants, such as the neurosurgeons whom I have mentioned, have less freedom to refer. That is why their patients throughout the country get a worse quality of care under Labour than they did under the previous Conservative Government--when, although I confess there could have been fewer constraints on extra-contractual referrals, there was a big improvement for GPs. The hon. Gentleman and I know that that was a great move forward for GP choice, which this Government have denied because they do not like doctors to have increased freedom.
The next pet project to be given extra funding is the new NHS logo. Everything must say "new" on it. Of course, there was not room to say "modern new NHS" on the logo. I wonder whether the Secretary of State will give us an idea of how much that will cost.
Those are minor points, although they tell us much about the Government and about the rotten culture that is eating away at them. They have no concern for truth and are obsessed by their own image and spin. What really matters, however, is what they are doing to patient care.
As the previous Secretary of State's adviser intimated, the Government themselves know that the waiting list initiative, one of the central parts of their policy, is deeply flawed, and distorting clinical priorities in our health care system. We have been told repeatedly by doctors throughout the country--I am sure that hon. Members on both sides of the House have heard it, and we have raised it here on several occasions--that clinical priorities are being distorted, with some of the sickest patients being made to wait longer while minor cases are moved up the list simply so that a bigger number are treated to make the figures look good for the sake of the politicians in Whitehall.
To put that those remarks into context, I should like to focus on a single case. The wife of a patient in County Durham wrote that her husband had been having chest pains on the treadmill and when playing golf. He consulted his GP on 17 February 1999. When he first saw a consultant it was 28 April 1999, and he told him that he thought a bypass would be needed and referred him to
South Cleveland hospital. He had an angiogram in September 1999. It was not until 22 March this year that he had a consultation with a consultant. In a letter dated 28 March, he was told
- the current waiting time for heart surgery is 12 months.
There is no way of knowing what will happen in any particular case--we all understand that--but the most important factor is that last year, 450 fewer cardiac bypass operations were carried out in the NHS than the year before--the first time in 25 years of the NHS carrying out those operations that there has been a fall, according to the cardiac register.
Does it not say everything about the culture and the way in which the Government are running the NHS that they increase the number of minor procedures, yet the number of coronary bypasses is going down? It confirms everything that we have said about the Government's approach to health care, their lack of clinical priority and their obsession with political priority.
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